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Bosqui T, Mayya A, Farah S, Shaito Z, Jordans MJD, Pedersen G, Betancourt TS, Carr A, Donnelly M, Brown FL. Parenting and family interventions in lower and middle-income countries for child and adolescent mental health: A systematic review. Compr Psychiatry 2024; 132:152483. [PMID: 38631272 DOI: 10.1016/j.comppsych.2024.152483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 08/31/2023] [Accepted: 04/02/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Given the protective effect of nurturing caregivers and families for child and adolescent mental health, there is a need to review and synthesize research evidence regarding the effectiveness of parenting and family interventions in low and middle-income countries, including humanitarian settings. To advance practice, further understanding of the active ingredients of such interventions and implementation factors that lead to effectiveness are essential. METHOD This systematic review, an update from a previous review, included studies on any parenting or family intervention for children and adolescents aged 0-24, living in a low- or middle-income country, that quantitatively measured child or adolescent mental health outcomes. We searched Global Health, PubMed, PsychINFO, PILOTS and the Cochrane Library databases on the 9th July 2020, and updated on the 12th August 2022. Risk of bias was assessed using an adapted version of the NIH Quality Assessment Tool. We extracted data on: effectiveness outcomes, practice elements included in effective interventions, and implementation challenges and successes. MAIN FINDINGS We found a total of 80 studies (n = 18,193 participants) representing 64 different family or parenting interventions, 43 of which had evidence of effect for a child or adolescent mental health outcome. Only 3 studies found no effect on child, adolescent or caregiver outcomes. The most common practice elements delivered in effective interventions included caregiver psychoeducation, communication skills, and differential reinforcement. Key implementation strategies and lessons learned included non-specialist delivery, the engagement of fathers, and integrated or multi-sector care to holistically address family needs. PRELIMINARY CONCLUSIONS Despite a high level of heterogeneity, preliminary findings from the review are promising and support the use of parenting and family interventions to address the wider social ecology of children in low resource and humanitarian contexts. There are remaining gaps in understanding mechanisms of change and the empirical testing of different implementation models. Our findings have implications for better informing task sharing from specialist to non-specialist delivery, and from individual-focused to wider systemic interventions.
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Affiliation(s)
- Tania Bosqui
- Department of Psychology, American University of Beirut, Beirut, Lebanon; Trinity Centre for Global Health, Trinity College Dublin, Republic of Ireland.
| | - Anas Mayya
- Department of Psychology, American University of Beirut, Beirut, Lebanon.
| | - Sally Farah
- Department of Psychology, American University of Beirut, Beirut, Lebanon.
| | - Zahraa Shaito
- Department of Psychology, American University of Beirut, Beirut, Lebanon.
| | - Mark J D Jordans
- War Child Alliance, Amsterdam, The Netherlands; Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, The Netherlands.
| | - Gloria Pedersen
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, the George Washington University School of Medicine and Health Sciences, Washington D.C., United States
| | | | - Alan Carr
- University College Dublin, Dublin, Republic of Ireland.
| | - Michael Donnelly
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom.
| | - Felicity L Brown
- War Child Alliance, Amsterdam, The Netherlands; Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, The Netherlands.
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Desrosiers A, Carrol B, Ritsema H, Higgins W, Momoh F, Betancourt TS. Advancing sustainable implementation of an evidence-based mental health intervention in Sierra Leone's schools: protocol for a hybrid type 3 implementation-effectiveness trial. BMC Public Health 2024; 24:362. [PMID: 38310232 PMCID: PMC10837990 DOI: 10.1186/s12889-024-17928-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/30/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Mental health disorders among youth contribute substantially to the global burden of disease, which is exacerbated in low- and middle-income countries (LMICs) due to large mental health treatment gaps. In Sierra Leone, a West African country with a long history of complex adversity, the mental health treatment gap is estimated at 98%. Implementing innovative mental health interventions that can be sustained at scale is a priority. The Youth Readiness Intervention (YRI) is an evidence-based mental health intervention for youth that can be delivered feasibly by lay health workers/nonspecialists. Using mobile-based technologies to assist implementation could improve the reach and sustainability of the YRI in Sierra Leone. This study aims to train teachers to deliver the YRI in Sierra Leone's secondary schools and test the feasibility, acceptability, cost, and fidelity to the YRI of a mobile-based supervision model compared with standard, in-person supervision. METHODS We will conduct a hybrid type 3 implementation-effectiveness cluster randomized trial to assess the feasibility, acceptability, costs and fidelity to the YRI implemented by teachers receiving mobile-based supervision vs. standard supervision. Enrolled schools (N = 50) will be randomized to YRI + mobile supervision (N = 20), YRI + standard supervision (N = 20) or waitlist control (N = 10). We will recruit and enroll four teachers per intervention-condition school (N = 160) and 1200 youth. We will collect data on implementation outcomes among teachers, principals and youth via a mixed methods approach at baseline and post-intervention. We will also collect quantitative data on youth mental health and functioning as secondary outcomes at baseline and post-intervention, as well as cost-effectiveness data at 12-month follow-up. DISCUSSION Study findings have the potential to expand the reach of mental health services among youth in low-resource settings via a teacher workforce. The use of mobile tools, if successful, could support further scale out and sustainment of the YRI to other regions of Sierra Leone and West Africa more broadly, which could help address the mental health treatment gap. TRIAL REGISTRATION Clinical Trial Network: NCT05737667.
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Affiliation(s)
- Alethea Desrosiers
- Department of Psychiatry and Human Behavior, Brown University, Warren Alport Medical School, 345 Blackstone Blvd Providence, Providence, RI, 02906, USA.
| | - Bidemi Carrol
- RTI International, 701 13th St NW #750, Washington, DC, 20005, USA
| | - Haley Ritsema
- Department of Psychiatry and Human Behavior, Brown University, Warren Alport Medical School, 345 Blackstone Blvd Providence, Providence, RI, 02906, USA
| | - Walker Higgins
- Innovations For Poverty Action, 47A&B Johnson Street, Freetown, Sierra Leone
| | - Fatoma Momoh
- Innovations For Poverty Action, 47A&B Johnson Street, Freetown, Sierra Leone
| | - Theresa S Betancourt
- Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA, 02496, USA
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Freeman JA, Desrosiers A, Schafer C, Kamara P, Farrar J, Akinsulure-Smith AM, Betancourt TS. The adaptation of a youth mental health intervention to a peer-delivery model utilizing CBPR methods and the ADAPT-ITT framework in Sierra Leone. Transcult Psychiatry 2024; 61:3-14. [PMID: 37822245 DOI: 10.1177/13634615231202091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
Low- and middle-income countries (LMICs) carry a significant proportion of the global burden of untreated mental health disorders. Peer-delivered programs offer LMICs with limited mental health professionals an opportunity to increase mental health service access. This study describes the process of adapting a lay-worker-delivered evidence-based youth mental health intervention to a peer-delivery model in Sierra Leone using participatory methods. We convened Youth Community Advisory Boards (YCABs) as partners to develop a peer-delivery model for an evidence-based intervention. In collaboration with YCABs, the Assessment, Decision, Administration, Production, Topical experts, Integration, Training, Testing (ADAPT-ITT) framework was applied to guide the adaptation. The ADAPT-ITT framework is an eight-step process to adapt evidence-based interventions. The ADAPT-ITT framework facilitated the adaptation of the Youth Readiness Intervention (YRI), an evidence-based mental health program intervention that has been delivered by adult lay-workers to the youth peer-delivery platform in Sierra Leone. The YCABs identified program modifications, including the incorporation of storytelling, refinement of metaphors, and alterations to make delivery more accessible to low-literacy youth with particular attention to gender. YCABs also provided recommendations on how to support youth facilitators in providing psychosocial support, emphasizing self-care and boundary setting to ensure high-quality intervention delivery and do-no-harm principles. Study findings suggest that the ADAPT-ITT framework can be feasibly applied to guide the intervention adaptation process in LMICs. The use of participatory methods generated modifications that reflected youth experiences, needs, and concerns as facilitators and participants. Next steps include refinement and pilot testing of the adapted intervention.
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Affiliation(s)
- Jordan A Freeman
- School of Social Work Research Program on Children and Adversity, Boston College, USA
| | | | - Carolyn Schafer
- School of Social Work Research Program on Children and Adversity, Boston College, USA
| | | | - Jordan Farrar
- School of Social Work Research Program on Children and Adversity, Boston College, USA
| | | | - Theresa S Betancourt
- School of Social Work Research Program on Children and Adversity, Boston College, USA
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Collier KM, Klein EK, Sevalie S, Molleh B, Kabba Y, Kargbo A, Bangura J, Gbettu H, Simms S, O'Leary C, Drury S, Schieffelin JS, Betancourt TS, Crea TM. Ebola Virus Disease Sensitization: Community-Driven Efforts in Sierra Leone. J Community Health 2024; 49:108-116. [PMID: 37531047 DOI: 10.1007/s10900-023-01265-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2023] [Indexed: 08/03/2023]
Abstract
The 2014-2016 West Africa Ebola outbreak was the largest in history, resulting in approximately 11,000 deaths. Despite the outbreak's eventual end, national and international health sensitization and containment efforts were subject to criticism. This study investigates disease-related knowledge and beliefs, as well as trusted sources of health information among EVD-survivors and their family members, highlighting the importance of community-informed public health responses. Participants (n = 134) were adults who were either EVD-infected, affected families/caregivers, or community leaders. In-depth interviews and focus groups explored EVD-related experiences, including health effects, stigma, and community relationships. Using a grounded theory and thematic content analysis approach, transcripts were coded for evidence of health sensitization, as well as compliance with mitigation measures and trusted sources of information. Participants displayed a high level of knowledge around EVD and reported compliance with mandated and personal prevention measures. Levels of health sensitization and subsequent reintegration of survivors were reported to be largely the products of community-based efforts, rather than the top-down, national public health response. Primary sources of trusted information included EVD survivors acting as peer educators; local leaders; and EVD sensitization by community health workers. This study highlights the importance of a community-based response for increasing the effectiveness of public health campaigns. Participants expressed that relying on the experiences of trusted cultural insiders led to a deeper understanding of Ebola compared to top-down public health campaigns, and helped infected and affected community members reintegrate. Future public health efforts should incorporate community-based participatory approaches to address infectious disease outbreaks.
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Affiliation(s)
- K Megan Collier
- School of Social Work, Boston College, Chestnut Hill, MA, USA.
| | | | | | | | - Yusuf Kabba
- Sierra Leone Association of Ebola Survivors, Freetown, Sierra Leone
| | - Abdulai Kargbo
- Sierra Leone Association of Ebola Survivors, Freetown, Sierra Leone
| | | | | | - Stewart Simms
- School of Social Work, Boston College, Chestnut Hill, MA, USA
| | - Clara O'Leary
- School of Social Work, Boston College, Chestnut Hill, MA, USA
| | - Stacy Drury
- School of Medicine, Tulane University, New Orleans, LA, USA
| | | | | | - Thomas M Crea
- School of Social Work, Boston College, Chestnut Hill, MA, USA
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Freeman JA, Farrar JC, Placencio-Castro M, Desrosiers A, Brennan RT, Hansen NB, Akinsulure-Smith AM, Su S, Bangura J, Betancourt TS. Integrating Youth Readiness Intervention and Entrepreneurship in Sierra Leone: A Hybrid Type II Cluster Randomized Trial. J Am Acad Child Adolesc Psychiatry 2023:S0890-8567(23)02254-2. [PMID: 38143022 DOI: 10.1016/j.jaac.2023.09.552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 09/03/2023] [Accepted: 09/14/2023] [Indexed: 12/26/2023]
Abstract
OBJECTIVE Conflict-affected youth are at risk for poor psychological and social outcomes, yet few receive mental health services. Strategies to expand access and sustain evidence-based interventions (EBIs) across novel delivery platforms must be tested. The present study was a hybrid type II implementation-effectiveness trial using a cluster randomized design. The primary goal was to evaluate feasibility and impact of using the collaborative team approach to deliver the Youth Readiness Intervention (YRI), an EBI, integrated into a youth entrepreneurship program (ENTR) with quality control in post-conflict Sierra Leone. METHOD Youth were screened and randomly assigned to control, ENTR, or combined YRI and ENTR (YRI+ENTR). Implementation outcomes were dissemination and implementation indicators, competence, and fidelity. Effectiveness outcomes were emotion regulation, psychological distress, and interpersonal functioning. Secondary outcomes were third-party reporter assessments of youth functioning and behavior. RESULTS Data were collected and analyzed from 1,151 youth participants and 528 third-party reporters. Scores on implementation constructs, competence, and fidelity demonstrated acceptable intervention response and quality. YRI+ENTR participants showed overall improvements in depression (β = -.081, 95% CI -0.124 to -0.038, d = -0.154) and anxiety (β = -.043, 95% CI -0.091 to -0.005, d = 0.082) symptoms compared with control participants. Community leaders indicated that YRI+ENTR participants demonstrated improvements in overall work or training performance compared with control participants (β = -.114, 95% CI 0.004 to 0.232, d = 0.374). CONCLUSION Integration of EBIs such as the YRI into youth employment programs has the potential to address limited reach of EBIs in conflict and post-conflict settings. A collaborative team implementation approach can facilitate integration and fidelity. DIVERSITY & INCLUSION STATEMENT We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. One or more of the authors of this paper received support from a program designed to increase minority representation in science. CLINICAL TRIAL REGISTRATION INFORMATION Youth FORWARD Phase 2 YRI and EPP Study; https://clinicaltrials.gov/; NCT03542500.
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Affiliation(s)
| | | | | | | | - Robert T Brennan
- National Initiative on Gender, Culture and Leadership in Medicine: C - Change, Women's Study Research Center, Brandeis University, Waltham, Massachusetts
| | | | | | - Shaobing Su
- Boston College, Chestnut Hill, Massachusetts
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Abdi S, Akinsulure-Smith AM, Sarkadi A, Fazel M, Ellis BH, Gillespie S, Juang LP, Betancourt TS. Promoting positive development among refugee adolescents. J Res Adolesc 2023; 33:1064-1084. [PMID: 37807940 DOI: 10.1111/jora.12890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 10/10/2023]
Abstract
Of the estimated 35.3 million refugees around the world (UNHCR, Figures at a Glance, 2022), approximately 50% are children under the age of 18. Refugee adolescents represent a unique group as they navigate developmental tasks in an unstable and often threatening environment or in resettlement contexts in which they often face marginalization. In addition to physiological, social, and psychological changes that mark adolescence, refugee youth often face traumatic experiences, acculturative stress, discrimination, and a lack of basic resources. In this consensus statement, we examine research on refugee adolescents' developmental tasks, acculturative tasks, and psychological adjustment using Suárez-Orozco and colleague's integrative risk and resilience model for immigrant-origin children and youth proposed by Suárez-Orozco et al. Finally, we discuss recommendations-moving from proximal to more distal contexts.
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Affiliation(s)
- Saida Abdi
- University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | | | | | | | | | - Sarah Gillespie
- University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
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7
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Desmond C, Watt KG, Jensen SKG, Simmons E, Murray SM, Farrar J, Placencio-Castro M, Sezibera V, Rawlings LB, Wilson B, Betancourt TS. Measuring the cost-effectiveness of a home-visiting intervention to promote early child development among rural families linked to the Rwandan social protection system. PLOS Glob Public Health 2023; 3:e0002473. [PMID: 37874790 PMCID: PMC10597512 DOI: 10.1371/journal.pgph.0002473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 09/14/2023] [Indexed: 10/26/2023]
Abstract
Early childhood development (ECD) programmes are heralded as a way to improve children's health and educational outcomes. However, few studies in developing countries calculate the effectiveness of quality early childhood interventions. This study estimates the cost and cost-effectiveness of the Sugira Muryango (SM) trial, a home-visiting intervention to improve ECD outcomes through positive parent-child relationships. Cost-effectiveness analysis of ECD interventions is challenging given their potential to have multiple benefits. We propose a cost-effectiveness method using a single outcome, in this case the improvement in cognitive development per home-visit session, as an indication of efficiency comparable across similar interventions. The trial intervention cost US$456 per family. This cost will likely fall below US$200 if the intervention is scaled through government systems. The cost-effectiveness analysis suggests that while SM generated a relatively small impact on markers of early development, it did so efficiently. The observed improvements in cognitive development per home-visit are similar to other home-visiting interventions of longer duration. SM by focusing on the family had benefits beyond ECD, including reductions in violence against children and intermate partner violence, further analysis is needed to include these returns in the economic evaluation.
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Affiliation(s)
- Chris Desmond
- Faculty of Health Sciences, SAMRC/Wits Centre for Health Economics and Decision Science, PRICELESS, University of Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Kathryn G. Watt
- Centre for Rural Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Sarah K. G. Jensen
- Boston College, School of Social Work, Chestnut Hill, Massachusetts, United States of America
| | - Erik Simmons
- Boston College, School of Social Work, Chestnut Hill, Massachusetts, United States of America
| | - Shauna M. Murray
- University of Massachusetts Boston, Boston, Massachusetts, United States of America
| | - Jordan Farrar
- Boston College, School of Social Work, Chestnut Hill, Massachusetts, United States of America
| | - Matias Placencio-Castro
- Boston College, Lynch School of Education and Human Development, Chestnut Hill, Massachusetts, United States of America
| | - Vincent Sezibera
- Centre for Mental Health, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | | | - Briana Wilson
- The World Bank, Washington, DC, United States of America
| | - Theresa S. Betancourt
- Boston College, School of Social Work, Chestnut Hill, Massachusetts, United States of America
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8
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Desrosiers A, Schafer C, Bond L, Akinsulure-Smith A, Hinton M, Vandi A, Betancourt TS. Exploring potential mental health spillover effects among caregivers and partners of youth in Sierra Leone: A qualitative study. Glob Ment Health (Camb) 2023; 10:e40. [PMID: 37854398 PMCID: PMC10579673 DOI: 10.1017/gmh.2023.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 06/20/2023] [Accepted: 07/07/2023] [Indexed: 10/20/2023] Open
Abstract
Given the large mental health treatment gap in low- and middle-income countries (LMICs), particularly in post-conflict settings like Sierra Leone, and the limited healthcare infrastructure, understanding the wider benefits of evidence-based mental health interventions within households is critical. This study explored potential mental health spillover effects - the phenomenon of beneficial effects among nonparticipants - among cohabitating caregivers and partners of youth who participated in an evidence-based mental health intervention in Sierra Leone. We recruited a sub-sample of cohabitating caregivers and partners (N = 20) of youth intervention participants; caregivers had enrolled in a larger study investigating indirect benefits of the evidence-based intervention in Sierra Leone (MH117359). Qualitative interviews were conducted at two time points to explore the following: (a) potential mental health spillover effects and (b) through which mechanisms spillover may have occurred. Two trained coders reviewed transcripts and analyzed qualitative data, assisted by MaxQDA. Qualitative findings suggested that spillover effects likely occurred and supported three potential mechanisms: decreased caregiving burden, behavior changes among Youth Readiness Intervention participants and improved interpersonal relationships. Mental health spillover effects may occur following youth intervention participation in a post-conflict LMIC. Investing in evidence-based services may offer indirect benefits that extend beyond those directly receiving services.
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Affiliation(s)
- Alethea Desrosiers
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Carolyn Schafer
- Institute for Public Health and Medicine, Northwestern University, Evanston, IL, USA
| | - Laura Bond
- Boston College School of Social Work, Chestnut Hill, MA, USA
| | | | | | - Alpha Vandi
- Caritas Sierra Leone, Freetown, Sierra Leone
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Bhutta ZA, Bhavnani S, Betancourt TS, Tomlinson M, Patel V. Adverse childhood experiences and lifelong health. Nat Med 2023; 29:1639-1648. [PMID: 37464047 DOI: 10.1038/s41591-023-02426-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/30/2023] [Indexed: 07/20/2023]
Abstract
With the advent of the sustainable development goals, the field of global child health has shifted its focus from reducing mortality to improving health, nutrition and development outcomes - often measured as human capital. A growing knowledge of the biology of development and neuroscience has highlighted the importance of adverse environmental exposures, collectively termed adverse childhood experiences (ACEs) on health outcomes. ACEs are associated with short-term, medium-term and long-term negative consequences for health and development and their effects may be multiplicative, especially during critical periods of sensitivity and developmental plasticity. Some of these effects are compounded by emerging global threats such as climate change, conflict and population displacement. In this Review, we discuss the key mechanisms linking ACEs to health outcomes and consider promising strategies to prevent and mitigate their effects, highlighting evidence from programs in low-income and middle-income countries. Finally, we emphasize the need for early recognition of ACEs and delivery of packages of interventions spanning key sectors such as health, education, women's empowerment and social protection.
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Affiliation(s)
- Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada.
- Institute for Global Health & Development, The Aga Khan University, South Central Asia, East Africa, United Kingdom, and Karachi, Pakistan.
| | | | | | - Mark Tomlinson
- Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
- School of Nursing and Midwifery, Queens University, Belfast, UK
| | - Vikram Patel
- Department of Global Health and Population, Harvard Chan School of Public Health, Boston, MA, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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10
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Klein EK, Bond L, McLean KE, Feika M, Bah AJ, Betancourt TS. Navigating the Tension between Fatherhood Ideals and Realities of a Post-Conflict Setting: A Phenomenological Study of Former Child Soldiers in Sierra Leone. SSM Qual Res Health 2023; 3:100227. [PMID: 38107407 PMCID: PMC10722571 DOI: 10.1016/j.ssmqr.2023.100227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
The concept of "fatherhood" in many African countries has traditionally been understood in terms of instrumental support to one's family, most notably, financial provision. However, in Sierra Leone and elsewhere, this narrow understanding of fatherhood is changing as a result of shifting demographic trends and responses to recent crises such as the Ebola pandemic and the aftermath of a civil war. Very little is understood about how male former children associated with armed forces and armed groups (CAAFAG) are navigating fatherhood and understanding their roles as fathers, particularly as many have grown up without fathers or parents themselves and experienced violence. Our study builds upon previous ethnographic research in Sierra Leone, and uses a phenomenological approach to understand 1) the meaning and importance of fatherhood to former child soldiers in Sierra Leone, 2) what fatherhood looks like normatively and ideally, with attention to norms about nurturing care as well as violence, and 3) how ideals of fatherhood may or may not be in tension with socioeconomic circumstances. We find that CAAFAG fathers in Sierra Leone are committed to providing emotional support, encouragement, and a loving upbringing in addition to striving to provide financially. CAAFAG fathers experienced the greatest tension between their ideals of fatherhood and their socio-economic circumstances in terms of financial support, such as paying school fees. In other words, fathers felt inhibited in becoming the types of fathers they hoped to be due to their experiences in a post-conflict, resource-constrained environment.
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Affiliation(s)
- Elizabeth K Klein
- Boston College School of Social Work, 140 Commonwealth Ave, Chestnut Hill, MA, 02467, USA
| | - Laura Bond
- Boston College School of Social Work, 140 Commonwealth Ave, Chestnut Hill, MA, 02467, USA
| | - Kristen E McLean
- International Studies Program, College of Charleston, 66 George Street, Charleston, SC, 29424, USA
| | - Mahmoud Feika
- Caritas Freetown, 19 Savage Street, Freetown, Sierra Leone
| | - Abdulai Jawo Bah
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, Musselburgh, Musselburgh, EH21 6UU, UK
| | - Theresa S Betancourt
- Boston College School of Social Work, 140 Commonwealth Ave, Chestnut Hill, MA, 02467, USA
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11
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Tol WA, Le PD, Harrison SL, Galappatti A, Annan J, Baingana FK, Betancourt TS, Bizouerne C, Eaton J, Engels M, Hijazi Z, Horn RR, Jordans MJD, Kohrt BA, Koyiet P, Panter-Brick C, Pluess M, Rahman A, Silove D, Tomlinson M, Uribe-Restrepo JM, Ventevogel P, Weissbecker I, Ager A, van Ommeren M. Mental health and psychosocial support in humanitarian settings: research priorities for 2021-30. Lancet Glob Health 2023; 11:e969-e975. [PMID: 37116530 PMCID: PMC10188364 DOI: 10.1016/s2214-109x(23)00128-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 02/23/2023] [Accepted: 03/02/2023] [Indexed: 04/30/2023]
Abstract
We describe an effort to develop a consensus-based research agenda for mental health and psychosocial support (MHPSS) interventions in humanitarian settings for 2021-30. By engaging a broad group of stakeholders, we generated research questions through a qualitative study (in Indonesia, Lebanon, and Uganda; n=101), consultations led by humanitarian agencies (n=259), and an expert panel (n=227; 51% female participants and 49% male participants; 84% of participants based in low-income and middle-income countries). The expert panel selected and rated a final list of 20 research questions. After rating, the MHPSS research agenda favoured applied research questions (eg, regarding workforce strengthening and monitoring and evaluation practices). Compared with research priorities for the previous decade, there is a shift towards systems-oriented implementation research (eg, multisectoral integration and ensuring sustainability) rather than efficacy research. Answering these research questions selected and rated by the expert panel will require improved partnerships between researchers, practitioners, policy makers, and communities affected by humanitarian crises, and improved equity in funding for MHPSS research in low-income and middle-income countries.
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Affiliation(s)
- Wietse A Tol
- Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Peter C Alderman Program for Global Mental Health, HealthRight International, New York, NY, USA; Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
| | - PhuongThao D Le
- Peter C Alderman Program for Global Mental Health, HealthRight International, New York, NY, USA; School of Global Public Health, New York University, New York, NY, USA
| | - Sarah L Harrison
- International Federation of Red Cross Red Crescent Societies Reference Centre for Psychosocial Support, Copenhagen, Denmark
| | - Ananda Galappatti
- Mental Health and Psychosocial Support Network (MHPSS.net), Colombo, Sri Lanka
| | - Jeannie Annan
- Airbel Impact Lab, The International Rescue Committee, New York, NY, USA
| | | | - Theresa S Betancourt
- Boston College, School of Social Work, Research Program on Children and Adversity, Chestnut Hill, MA, USA
| | - Cecile Bizouerne
- Mental Health, PsychoSocial Support and Protection Sector, Action Contre la Faim, Paris, France
| | - Julian Eaton
- Centre for Global Mental Health, London School of Hygiene & Tropical Medicine, London, UK; CBM Global, Amstelveen, Netherlands
| | | | - Zeinab Hijazi
- Mental Health Unit, Programme Division, UNICEF, New York, NY, USA
| | - Rebecca R Horn
- Institute for Global Health & Development, Queen Margaret University, Edinburgh, UK
| | - Mark J D Jordans
- Centre for Global Mental Health, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK; Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, Netherlands
| | - Brandon A Kohrt
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA
| | | | - Catherine Panter-Brick
- Department of Anthropology and Jackson School of Global Affairs, Yale University, New Haven, CT, USA
| | - Michael Pluess
- Department of Biological and Experimental Psychology, Queen Mary University of London, London, UK
| | - Atif Rahman
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | | | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa; School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | | | - Peter Ventevogel
- Public Health Section, Division of Resilience and Solutions, United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - Inka Weissbecker
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Alastair Ager
- Institute for Global Health & Development, Queen Margaret University, Edinburgh, UK; Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Mark van Ommeren
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
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12
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Frounfelker RL, Mishra T, Holmes KB, Gautam B, Betancourt TS. Mental health among older Bhutanese with a refugee life experience: A mixed-methods latent class analysis study. Am J Orthopsychiatry 2023; 93:304-315. [PMID: 37155291 PMCID: PMC10330824 DOI: 10.1037/ort0000684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
There are disparities in the mental health of refugee populations compared to individuals who have not experienced forced migration. It is important to identify individuals with a refugee life experience who are most in need of mental health care and prioritize their engagement in services. The objectives of this convergent mixed-methods study are to quantitatively identify the association between exposure to pre- and postresettlement traumas and stressors and mental health among older adults with a refugee life experience, qualitatively identify typologies of narratives of forced migration, and integrate findings to provide a more comprehensive understanding of the relationship between trauma and symptoms of posttraumatic stress disorder (PTSD). Study participants were Bhutanese with a refugee life experience living in a metropolitan area in New England (United States). We used quantitative surveys to identify exposures to traumas and symptoms of PTSD. We used latent class analysis to identify subgroups of trauma exposure and association with symptoms of PTSD. A subset of individuals participated in qualitative interviews. Narrative thematic analysis was used to explore typologies of life history narratives. Quantitatively, we identified four classes of patterns of trauma exposure throughout the refugee life trajectory. These classes were associated with current symptoms of PTSD. Qualitatively, we identified four narrative types that indicate participants interpreted and made sense of their life trajectories in a variety of ways. Integration of findings indicate that caution is needed in identifying individuals in need of mental health services and the best approach for interventions that promote psychosocial well-being. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | - Tej Mishra
- Washington, D.C. Department of Public Health
| | - Kieran B. Holmes
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University
| | - Bhuwan Gautam
- Department of Public Health Sciences, Penn State College of Medicine
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13
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Jensen SKG, Murray SM, Placencio-Castro M, Kajani U, Amponsah D, Sezibera V, Betancourt TS. Family Violence Reduction Within a Parenting Intervention in Rwanda: A Mixed-Methods Study. Pediatrics 2023; 151:191223. [PMID: 37125890 DOI: 10.1542/peds.2023-060221l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES A mixed-methods study of mechanisms of change through which a home-visiting-based early childhood development intervention, Sugira Muryango ("strong family"), reduced violent discipline and intimate partner violence in Rwanda. METHODS The cluster-randomized trial of Sugira Muryango enrolled socioeconomically vulnerable families with children aged 6 to 36 months in rural Rwanda. We interviewed 18 female caregivers early in the intervention, and 21 female caregivers and 11 male intimate partners were interviewed after the intervention. Coded interviews identify risk factors for violence and mechanisms of intervention-related change in violence. Quantitative analyses included 931 caregivers (52.6% female) who lived with an intimate partner to examine risk factors for violence, intervention effects, and mechanisms of violence reduction. RESULTS The qualitative data identified daily hardships and alcohol problems as risk factors for violent discipline and intimate partner violence. Through Sugira Muryango, caregivers learned that strong relationships between partners and engagement of male caregivers in child care has positive impacts on children's development. Techniques taught by community lay workers improved communication, promoted positive parent-child interactions, and reduced intimate partner violence and violent discipline. Quantitative analyses also found that daily hardships predict violent discipline and intimate partner violence. Sugira Muryango reduced violent discipline, increased father engagement, and increased female caregiving warmth. Moreover, pre- to postintervention change in caregiving warmth was associated with reduced use of violent discipline among female caregivers and marginally associated with reduced female victimization. CONCLUSIONS Violence reduction can be integrated into early child development programs to reduce violent discipline and intimate partner violence.
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Affiliation(s)
| | - Shauna M Murray
- School for Global Inclusion and Social Development, University of Massachusetts Boston, Boston, Massachusetts
| | - Matias Placencio-Castro
- School of Social Work
- Lynch School of Education, Boston College, Chestnut Hill, Massachusetts
| | | | | | - Vincent Sezibera
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
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14
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Black CJ, Berent JM, Joshi U, Khan A, Chamlagai L, Shrivastava R, Gautam B, Negeye A, Iftin AN, Ali H, Desrosiers A, Bhan A, Bhattacharya S, Naslund JA, Betancourt TS. Applying Human-Centered Design in Global Mental Health to Improve Reach Among Underserved Populations in the United States and India. Glob Health Sci Pract 2023; 11:GHSP-D-22-00312. [PMID: 36853639 PMCID: PMC9972370 DOI: 10.9745/ghsp-d-22-00312] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 01/24/2023] [Indexed: 03/01/2023]
Abstract
INTRODUCTION Human-centered design (HCD) refers to a diverse suite of interactive processes that engage end users in the development of a desired outcome. We showcase how 2 global mental health research teams applied HCD to develop mobile health tools, each directed at reducing treatment gaps in underserved populations. CASE STUDY 1: Refugees face higher risks for mental health problems, yet these communities face structural and cultural barriers that reduce access to and use of services. To address these challenges, the Research Program on Children and Adversity at the Boston College School of Social Work, in partnership with resettled refugee communities in the northeastern United States, used codesign methodology to digitally adapt delivery of the Family Strengthening Intervention for Refugees-a program designed to improve mental health and family functioning among resettled families. We describe how codesign methods support the development of more feasible, acceptable, and sustainable interventions. CASE STUDY 2: Sangath, an NGO in India focused on mental health services research, in partnership with Harvard Medical School, designed and evaluated a digital training program for community health workers to deliver an evidence-based, brief psychological treatment for depression as part of primary care in Madhya Pradesh, India. We describe how HCD was applied to program development and discuss our approach to scaling up training and capacity-building to deliver evidence-based treatment for depression in primary care. IMPLICATIONS HCD involves a variety of techniques that can be flexibly adapted to engage end users in the conceptualization, implementation, scale-up, and sustainment of global mental health interventions. Community solutions generated using HCD offer important benefits for key stakeholders. We encourage widespread adoption of HCD within global mental health policy, research, and practice, especially for addressing mental health disparities with underserved populations.
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Affiliation(s)
- Candace J. Black
- Research Program on Children and Adversity, School of Social Work, Boston College, Boston, MA, USA.,Correspondence to Candace J. Black ()
| | - Jenna M. Berent
- Research Program on Children and Adversity, School of Social Work, Boston College, Boston, MA, USA
| | - Udita Joshi
- Bangalore Hospice Trust – Karunashraya Institute for Palliative Care Education and Research, Bangalore, India.,Sangath, Bhopal, India
| | | | - Lila Chamlagai
- Community member from the resettled Bhutanese community, Springfield, MA, USA
| | | | - Bhuwan Gautam
- Research Program on Children and Adversity, School of Social Work, Boston College, Boston, MA, USA.,Community member from the resettled Bhutanese community, Springfield, MA, USA
| | - Abdikadir Negeye
- Community member from the resettled Somali Bantu community, Lewiston, ME, USA
| | - Abdi Nor Iftin
- Community member from the resettled Somali Bantu community, Lewiston, ME, USA
| | - Halimo Ali
- Community member from the resettled Somali Bantu community, Lewiston, ME, USA
| | - Alethea Desrosiers
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | | | | | - John A. Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Cambridge, MA, USA
| | - Theresa S. Betancourt
- Research Program on Children and Adversity, School of Social Work, Boston College, Boston, MA, USA
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15
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Desrosiers A, Bond L, Hoffman M, Kumar P, Schafer C, Metzger IW, Vandi A, Hinton M, Betancourt TS. Exploring Naturalistic Diffusion of an Evidence-Based Mental Health Intervention across Peer Networks of Youth in Sierra Leone. Int J Environ Res Public Health 2023; 20:4059. [PMID: 36901069 PMCID: PMC10002214 DOI: 10.3390/ijerph20054059] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/13/2023] [Accepted: 02/22/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Understanding the mechanisms by which evidence-based interventions (EBIs) for mental health are naturally diffused among youth in low-and middle-income countries-particularly those with histories of violence and civil unrest-can illuminate which intervention elements are most transferrable and inform scale-up decisions that support youth adjustment. This study explored the diffusion of an evidence-based mental health intervention-the Youth Readiness Intervention (YRI)-among peer networks of Sierra Leonean youth (aged 18-30) who participated in a trial of the intervention as integrated into youth entrepreneurship programs. METHODS Trained research assistants recruited index participants who had completed the YRI integrated within entrepreneurship training (N = 165) and control index participants (N = 165). Index participants nominated three of their closest peers. Nominated peers were recruited and enrolled in the current study (N = 289). A sub-sample of index participants and peers participated in dyadic interviews (N = 11) and focus group discussions (N = 16). Multivariate regression analysis compared YRI knowledge levels among YRI participants' peers relative to control participants' peers. RESULTS Qualitative findings supported the diffusion of several YRI skills and components across peer networks (i.e., progressive muscle relaxation and diaphragmatic breathing). Quantitative findings indicated that YRI knowledge was significantly higher for YRI participants' peers (β = 0.02, p < 0.00) compared to control participants' peers. CONCLUSION Findings suggest that diffusion of evidence-based intervention components can occur naturally among peers in post-conflict LMIC settings. Developing tools to promote the diffusion of the most transferrable EBI components across peer networks could help maximize the benefits of mental health interventions for youth adjustment and resilience in post-conflict settings.
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Affiliation(s)
- Alethea Desrosiers
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI 02906, USA
| | - Laura Bond
- School of Social Work, Boston College, Chestnut Hill, MA 02496, USA
| | - Morgan Hoffman
- School of Social Work, Boston College, Chestnut Hill, MA 02496, USA
| | - Praveen Kumar
- School of Social Work, Boston College, Chestnut Hill, MA 02496, USA
| | - Carolyn Schafer
- Institute for Public Health and Medicine, Northwestern University, Evanston, IL 60208, USA
| | - Isha W. Metzger
- College of Arts and Sciences, Georgia State University, Atlanta, GA 30302, USA
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16
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DiClemente-Bosco K, Neville SE, Berent JM, Farrar J, Mishra T, Abdi A, Beardslee WR, Creswell JW, Betancourt TS. Understanding mechanisms of change in a family-based preventive mental health intervention for refugees by refugees in New England. Transcult Psychiatry 2023; 60:142-155. [PMID: 35989681 PMCID: PMC9943782 DOI: 10.1177/13634615221111627] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Transnational migration of refugees is associated with poor mental health, particularly among children. We conducted a pilot trial of the Family Strengthening Intervention for Refugees (FSI-R), using a community-based participatory research (CBPR) approach to deliver a home-based intervention "for refugees by refugees" to improve family functioning and child mental health. N = 80 refugee families in the Greater Boston area participated in the study (n = 40 Somali Bantu families; n = 40 Bhutanese families) with n = 41 families randomized to care-as-usual. Of the 39 families who received FSI-R, n = 36 caregivers and children completed qualitative exit interviews. We present findings from these interviews to identify the mechanisms through which a family-strengthening intervention for refugees can be acceptable, feasible, and effective at improving family functioning and children's mental health outcomes. Authors applied Grounded Theory to code interview transcripts and detailed field notes and used an iterative process to arrive at final codes, themes, and a theoretical framework. The greatest contributors to acceptability and feasibility included flexibility in scheduling intervention sessions, the interventionist being a community member, and improvements to family communication and time spent together. All of these factors were made possible by the CBPR approach. Our findings suggest that given the socio-political context within the U.S. and the economic challenges faced by refugee families, the successful implementation of such interventions hinges on culturally-grounding the intervention design process, drawing heavily on community input, and prioritizing community members as interventionists.
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Affiliation(s)
- Kira DiClemente-Bosco
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Sarah Elizabeth Neville
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA, USA
| | - Jenna M. Berent
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA, USA
| | - Jordan Farrar
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA, USA
| | - Tej Mishra
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA, USA
| | - Abdirahman Abdi
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA, USA
| | | | - John W. Creswell
- Department of Family Medicine, University of Michigan Medical School, Dexter, MI, USA
| | - Theresa S. Betancourt
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA, USA
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17
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Bunn M, Zolman N, Smith CP, Khanna D, Hanneke R, Betancourt TS, Weine S. Family-based mental health interventions for refugees across the migration continuum: A systematic review. SSM - Mental Health 2022. [PMID: 37529116 PMCID: PMC10392776 DOI: 10.1016/j.ssmmh.2022.100153] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
This study reviewed the literature on family-based mental health interventions for refugees across migration contexts and settings to identify types of interventions and intervention components, implementation approaches and to assess effectiveness. The review used a systematic approach, and ten intervention studies were retained for analysis. The findings identified three primary types of family-based mental health interventions used with diverse refugee communities in settings in the Global North and South-parenting groups, multiple family groups and home visiting interventions. Findings indicated that non-specialized or peer providers were frequently utilized to deliver the interventions though additional details on the workforce and workforce development strategies are needed to better understand how to sustain and support such providers. The findings suggest that family-based mental health interventions are potentially effective for improving a range of child and caregiver mental health outcomes and improving family processes and functioning among refugee families. However, the empirical evidence is quite limited to date, with a need for additional rigorous studies, especially with refugee families in humanitarian settings, to further build the evidence base.
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18
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Crea TM, Collier KM, Klein EK, Sevalie S, Molleh B, Kabba Y, Kargbo A, Bangura J, Gbettu H, Simms S, O'Leary C, Drury S, Schieffelin JS, Betancourt TS. Social distancing, community stigma, and implications for psychological distress in the aftermath of Ebola virus disease. PLoS One 2022; 17:e0276790. [PMID: 36322544 PMCID: PMC9629629 DOI: 10.1371/journal.pone.0276790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022] Open
Abstract
Background The 2013–2016 Ebola virus disease (EVD) epidemic resulted in more infections and deaths than all prior outbreaks in the 40-year history of this virus combined. This study examines how experiences of EVD infection, and preventive measures such as social distancing, were linked to experiences of stigma and social exclusion among those reintegrating into their communities. Methods Key informant interviews (n = 42) and focus group discussions (n = 27) were conducted in districts with a high prevalence of EVD and representing geographical and ethnic diversity (n = 228 participants). The final sample was composed of adults (52%) and children (48%) who were EVD-infected (46%) and -affected (42%) individuals, and community leaders (12%). Data were coded using a Grounded Theory approach informed by Thematic Content Analysis, and analyzed using NVivo. Interrater reliability was high, with Cohen’s κ = 0.80 or higher. Findings Participants described two main sources of EVD-related stress: isolation from the community because of social distancing and other prevention measures such as quarantine, and stigma related to infected or affected status. Participants linked experiences of social isolation and stigma to significant distress and feelings of ostracization. These experiences were particularly pronounced among children. Sources of support included community reintegration over time, and formal community efforts to provide education and establish protection bylaws. Interpretation This study found that social distancing and EVD-related stigma were each prominent sources of distress among participants. These results suggest that isolation because of infection, and the enduring stigmatization of infected individuals and their families, demand coordinated responses to prevent and mitigate additional psychosocial harm. Such responses should include close engagement with community leaders to combat misinformation and promote community reintegration.
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Affiliation(s)
- Thomas M Crea
- School of Social Work, Boston College, Chestnut Hill, Massachusetts, United States of America
| | - K Megan Collier
- School of Social Work, Boston College, Chestnut Hill, Massachusetts, United States of America
| | - Elizabeth K Klein
- School of Social Work, Boston College, Chestnut Hill, Massachusetts, United States of America
| | | | | | - Yusuf Kabba
- Sierra Leone Association of Ebola Survivors, Freetown, Sierra Leone
| | - Abdulai Kargbo
- Sierra Leone Association of Ebola Survivors, Freetown, Sierra Leone
| | | | | | - Stewart Simms
- School of Social Work, Boston College, Chestnut Hill, Massachusetts, United States of America
| | - Clara O'Leary
- School of Social Work, Boston College, Chestnut Hill, Massachusetts, United States of America
| | - Stacy Drury
- School of Medicine, Tulane University, New Orleans, Louisiana, United States of America
| | - John S Schieffelin
- School of Medicine, Tulane University, New Orleans, Louisiana, United States of America
| | - Theresa S Betancourt
- School of Social Work, Boston College, Chestnut Hill, Massachusetts, United States of America
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19
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Frounfelker RL, Mishra T, Carroll A, Brennan RT, Gautam B, Ali EAA, Betancourt TS. Past trauma, resettlement stress, and mental health of older Bhutanese with a refugee life experience. Aging Ment Health 2022; 26:2149-2158. [PMID: 34396853 PMCID: PMC9386683 DOI: 10.1080/13607863.2021.1963947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/30/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Older displaced persons often receive limited attention from aid organizations, policy-makers and service providers in countries of resettlement. The objective of this study is to identify the relationship between experiencing traumatic events and stressors prior to resettlement, current resettlement stressors, social support, and mental health of older Bhutanese with a refugee life experience. METHOD Study participants were 190 older Bhutanese with a refugee life experience living in a metropolitan area in New England (US) and Ontario (Canada). We used structural equation modeling to determine the association between traumatic and stressful events in Bhutan and Nepal, current resettlement stressors, and symptoms of anxiety and depression, as measured by the GAD-7 and PHQ-9. We assessed the role of social support as an effect modifier in the relationship between these variables. RESULTS Surviving torture was associated with anxiety (p=.006), and experiencing threats to physical wellbeing in Nepal was associated with both anxiety (p=.003) and depression (p=.002). The relationship between physical threats in Nepal and current mental health were partially mediated by resettlement stressors. Social support moderated the relationship between trauma, stress, and mental health. CONCLUSION Both past traumas and current resettlement stressors contribute to the current psychosocial functioning of older Bhutanese with a refugee life experience. Based on our findings, social support is critical in promoting mental health in this population.
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Affiliation(s)
- Rochelle L Frounfelker
- Division of Social and Transcultural Psychiatry, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Tej Mishra
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA, USA
| | - Alexa Carroll
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Robert T Brennan
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA, USA
- Women's Study Research Center, Brandeis University, Waltham, MA, USA
| | - Bhuwan Gautam
- Bhutanese Society of Western Massachusetts, Inc., Springfield, MA, USA
| | - Eman Abdullahi Alas Ali
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Theresa S Betancourt
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA, USA
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20
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Neville SE, DiClemente-Bosco K, Chamlagai LK, Bunn M, Freeman J, Berent JM, Gautam B, Abdi A, Betancourt TS. Investigating Outcomes of a Family Strengthening Intervention for Resettled Somali Bantu and Bhutanese Refugees: An Explanatory Sequential Mixed Methods Study. Int J Environ Res Public Health 2022; 19:12415. [PMID: 36231735 PMCID: PMC9566609 DOI: 10.3390/ijerph191912415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/21/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
Pre- and post-migration stressors can put resettled refugee children at risk of poor mental health outcomes. The Family Strengthening Intervention for Refugees (FSI-R) is a peer-delivered preventative home visiting program for resettled refugees that aims to draw upon families' strengths to foster improved family communication, positive parenting, and caregiver-child relationships, with the ultimate goal of reducing children's risk of mental health problems. Using an explanatory sequential mixed methods design, this study draws upon qualitative interviews with caregivers (n = 19) and children (n = 17) who participated in a pilot study of the FSI-R intervention in New England, as well as interventionists (n = 4), to unpack quantitative findings on mental health and family functioning from a randomized pilot study (n = 80 families). Most patterns observed in the quantitative data as published in the pilot trial were triangulated by qualitative data. Bhutanese caregivers and children noted that children were less shy or scared to speak up after participating in the FSI-R. Somali Bantu families spoke less about child mental health and underscored feasibility challenges like language barriers between caregivers and children. Interventionists suggested that families with higher levels of education were more open to implementing behavior change. In both groups, families appreciated the intervention and found it to be feasible and acceptable, but also desired additional help in addressing broader family and community needs such as jobs and literacy programs.
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Affiliation(s)
- Sarah Elizabeth Neville
- Intenational Health Institute, School of Public Health, Brown University, Providence, RI 02903, USA
| | - Kira DiClemente-Bosco
- Center for Dissemination and Implementation Science, Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Lila K. Chamlagai
- Brown Mindfulness Center, Behavioral Health and Social Science Department, School of Public Health, Brown University, Providence, RI 02903, USA
| | - Mary Bunn
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Jordan Freeman
- Bill & Melinda Gates Institute for Population and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Jenna M. Berent
- Research Program on Children in Adversity, School of Social Work, Boston College, Chestnut Hill, MA 02467, USA
| | - Bhuwan Gautam
- College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA
| | | | - Theresa S. Betancourt
- Research Program on Children in Adversity, School of Social Work, Boston College, Chestnut Hill, MA 02467, USA
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Lansford JE, Betancourt TS, Boller K, Popp J, Altafim ERP, Attanasio O, Raghavan C. The Future of Parenting Programs: II Implementation. Parent Sci Pract 2022; 22:235-257. [PMID: 36439707 PMCID: PMC9683038 DOI: 10.1080/15295192.2022.2086807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Jennifer E Lansford
- Center for Child and Family Policy, Duke University, Box 90545, Durham, NC 27708, USA
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22
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Thulin EJ, McLean KE, Sevalie S, Akinsulure-Smith AM, Betancourt TS. Mental health problems among children in Sierra Leone: Assessing cultural concepts of distress. Transcult Psychiatry 2022; 59:461-478. [PMID: 32316867 DOI: 10.1177/1363461520916695] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Globally, over 13% of children and adolescents are affected by mental disorders, yet relatively little scholarship addresses how risk factors, symptoms, and nosology vary by culture and context, especially in young children living in post-conflict and low-resource settings. To address this gap, we conducted a qualitative study to identify and describe the most salient mental health problems facing children aged 6 to 10 years in Sierra Leone, as well as the thoughts, feelings, and behaviors related to these problems. Free list interviews (N = 200) and semi-structured interviews (N = 66) were conducted among caregivers, children, and other relevant key informants to explore risk factors and locally meaningful concepts of distress. Our findings indicate that children are faced with a variety of challenges in their social environments that contribute to distress, including hunger, unmet material needs, and excessive work. Our research identifies five contextually defined mental health problems faced by young children: gbos gbos (angry, destructive behavior), poil at (sad, disruptive behavior), diskoraj (sad, withdrawn), wondri (excessive worry), and fred fred (abnormal fear). The manifestations of these distress concepts are described in detail and contextualized according to Sierra Leone's history of war and current backdrop of poverty and insecurity. Implications are discussed for locally relevant diagnosis and treatment as well as for the wider literature on global child mental health.
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Affiliation(s)
- Elyse J Thulin
- Department of Health Behavior & Health Education, University of Michigan, Ann Arbor, MI, USA
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Desrosiers A, Freeman J, Mitra R, Bond L, Santo LD, Farrar J, Borg R, Jambai M, Betancourt TS. Alternative Delivery Platforms for Expanding Evidence-based Mental Health Interventions for Youth in Sierra Leone: A Pilot Study. Vulnerable Child Youth Stud 2022; 18:131-142. [PMID: 36684805 PMCID: PMC9857864 DOI: 10.1080/17450128.2022.2094518] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 06/20/2022] [Indexed: 06/01/2023]
Abstract
Given the high rates of mental health problems and poor service access among youth in war-affected countries throughout Sub-Saharan Africa, incorporating evidence-based mental health interventions into alternative delivery platforms could improve service access in these settings. We conducted a randomized controlled pilot study with high-risk Sierra Leonean youth to investigate the feasibility of implementing the Youth Readiness Intervention (YRI), a cognitive behavioral and interpersonal therapy-based group intervention, within an employment promotion program (EPP) and preliminary effects of the YRI on mental health outcomes. Participants were 175 youth (females=62%) ages 18-30 recruited via flyers and radio announcements. Participants were assigned to geographic clusters stratified by gender; clusters were randomized into YRI+EPP (n=58) or EPP-only (n=57). Statistically matched controls were recruited from comparable chiefdoms (n=60). The 12-session YRI was delivered bi-weekly, following EPP completion. Qualitative findings indicated that the YRI was highly feasible and acceptable as integrated into the EPP. Mixed linear effects models showed promising trends. Compared with controls, both YRI+EPP and EPP-only males reported significantly reduced post-traumatic stress symptoms, and YRI+EPP reported marginally significantly reduced emotional regulation difficulties. EPP-only females reported significantly reduced functional impairment compared to controls. Findings suggest that the YRI can be feasibly implemented within an EPP. Integrating the YRI into existing delivery platforms may help increase access to mental health care in Sierra Leone and provide a leverage point for scaling up evidence-based mental health interventions in other low-resource settings globally. [Clinicaltrials.gov; NCT0360361; 5/18/18].
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Affiliation(s)
- Alethea Desrosiers
- Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA 02467
| | - Jordan Freeman
- Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA 02467
| | - Romita Mitra
- Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA 02467
| | - Laura Bond
- Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA 02467
| | - Leila Dal Santo
- Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA 02467
| | - Jordan Farrar
- Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA 02467
| | - Ryan Borg
- Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA 02467
| | - Musu Jambai
- Caritas-Freetown, 19 Savage Street, Freetown, Sierra Leone
| | - Theresa S. Betancourt
- Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA 02467
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Brown FL, Bosqui T, Elias J, Farah S, Mayya A, Abo Nakkoul D, Walsh B, Chreif S, Einein A, Meksassi B, Abi Saad R, Naal H, Ghossainy ME, Donnelly M, Betancourt TS, Carr A, Puffer E, El Chammay R, Jordans MJD. Family systemic psychosocial support for at-risk adolescents in Lebanon: study protocol for a multi-site randomised controlled trial. Trials 2022; 23:327. [PMID: 35436976 PMCID: PMC9014280 DOI: 10.1186/s13063-022-06284-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Adolescents growing up in communities characterised by adversity face multiple risk factors for poor mental health and wellbeing. There is currently a scarcity of research on effective approaches for preventing and treating psychological distress in this population, particularly in humanitarian settings. The powerful impact of the home environment and family support is well known; however, approaches targeting the family are seldom developed or evaluated in such settings. We developed a brief family systemic psychosocial support intervention to be delivered through existing child protection systems with non-specialist facilitators. This paper outlines the study protocol for a randomised controlled trial of the intervention in Lebanon. Methods We will conduct a single-blind hybrid effectiveness-implementation multi-site RCT comparing the locally developed systemic family intervention to a waitlist control group for families residing in vulnerable regions in North Lebanon and Beqaa governorates (including families of Syrian, Palestinian, and Lebanese backgrounds). Outcomes on a range of family, adolescent, and caregiver measures will be assessed at baseline (T0) and post-intervention (T1), and at a 3-month follow-up for the treatment arm (T2). Families will be eligible for the trial if they are identified by implementing organisations as being medium-to-high risk for child protection concerns and have one or more adolescent aged 12–17 who demonstrates significant psychological distress on a self-report brief screening tool. Families will be randomly assigned to a treatment or a waitlist control condition. Families in the waitlist condition will receive a group version of the programme after completion of the study, to allow us to assess feasibility, acceptability, and preliminary indications of intervention effects of this modality. The primary outcome is reduction in overall adolescent-reported psychological distress over time, with post-intervention (T1) as the primary endpoint. Secondary adolescent-reported outcomes include family functioning, psychosocial wellbeing, and emotional regulation difficulties. Secondary caregiver-reported outcomes include parenting style, family functioning, psychological distress, and emotional regulation difficulties. Discussion This trial will provide the first assessment of the effectiveness of the family systemic psychosocial support intervention for use in Lebanon, with important implications for the use of systemic, low-cost, non-specialist interventions for this age range. Trial registration Local registry: National Mental Health Program, Ministry of Public Health, Lebanese Republic. Registered on 19 October 2021 Lebanese Clinical Trial Registry LBCTR2021104870. Registered on 13 October 2021 Global registry: ISRCTN ISRCTN13751677. Registered on 1 November 2021
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Bond L, Farrar J, Borg RC, Keegan K, Journeay K, Hansen N, Mac-Boima E, Rassin A, Betancourt TS. Alternate delivery platforms and implementation models for bringing evidence-based behavioral interventions to scale for youth facing adversity: a case study in West Africa. Implement Sci Commun 2022; 3:16. [PMID: 35168661 PMCID: PMC8848683 DOI: 10.1186/s43058-022-00259-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 01/18/2022] [Indexed: 11/17/2022] Open
Abstract
Background Youth Functioning and Organizational Success for West African Regional Development (Youth FORWARD) was launched as an implementation science collaboration focused on scaling out evidence-based mental health interventions for youth exposed to war and other adversities through novel delivery platforms. This implementation science case study examines the use of a collaborative team approach (CTA) as a scale-out strategy to foster the integration of an evidence-based group mental health intervention, the Youth Readiness Intervention, into youth employment programs tied to regional economic development in Sierra Leone. Methods A case study methodology is used to explore the feasibility and acceptability of integrating an evidence-based intervention, the Youth Readiness Intervention (YRI), into youth entrepreneurship programs (ENTR) in Sierra Leone, facilitated by the CTA. The authors analyzed field notes logged during program implementation, 8 weeks of supervision notes, 20 interviews with agency leaders and front-line staff delivering the YRI within this alternate delivery platform. Quantitative dissemination and implementation interviews administered to youth, facilitators, and agency leaders were analyzed using descriptive statistics and mixed linear models. A linked Hybrid Type II effectiveness-implementation cluster randomized trial is evaluating the clinical effectiveness of the YRI within this delivery platform. Results Extant data indicate the strong feasibility and acceptability of integrating the YRI into the ENTR program. Facilitators of integration of the YRI into the ENTR include mission alignment of the organizations with the delivery of psychosocial interventions, shared commitment to serving vulnerable youth, support from local District Youth Councils, and high interest from the youth served. Barriers include perceived competition between frontline organizations seeking funding for psychosocial interventions, and challenges in flexibility between donors and implementation partners operating in a fragile/post-conflict setting. The CTA was a feasible and acceptable strategy to support fidelity and quality improvement while scaling out the YRI. Conclusions Youth entrepreneurship and livelihood programs offer a promising mechanism for expanding the reach of evidence-based interventions to youth in fragile and post-conflict settings. Quality improvement and sustainment of evidence-based interventions are novel concepts in such settings. The CTA strategy institutionalizes the integration of an evidence-based intervention into youth entrepreneurship programs. Trial registration NCT03603613 (phase 1 pilot, registered May 18, 2018) and NCT03542500 (phase 2 scale-out study, registered May 18, 2018).
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Affiliation(s)
- Laura Bond
- Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA
| | - Jordan Farrar
- Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA
| | - Ryan C Borg
- Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA
| | - Katrina Keegan
- Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA
| | - Katharine Journeay
- Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA
| | - Nathan Hansen
- University of Georgia College of Public Health, Health Sciences Campus, Athens, GA, 30602, USA
| | | | - Alimamy Rassin
- Caritas Sierra Leone, 19 Savage Street, Freetown, Sierra Leone
| | - Theresa S Betancourt
- Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA.
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Antonaccio CM, Pham P, Vinck P, Collet K, Brennan RT, Betancourt TS. Fear, distress, and perceived risk shape stigma toward Ebola survivors: a prospective longitudinal study. BMC Public Health 2021; 21:2066. [PMID: 34763704 PMCID: PMC8581958 DOI: 10.1186/s12889-021-12146-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 10/25/2021] [Indexed: 11/28/2022] Open
Abstract
Background During the 2014–15 Ebola Virus Disease (EVD) epidemic, thousands of people in Sierra Leone were infected with the devastating virus and survived. Years after the epidemic was declared over, stigma toward EVD survivors and others affected by the virus is still a major concern, but little is known about the factors that influence stigma toward survivors. This study examines how key personal and ecological factors predicted EVD-related stigma at the height of the 2014–2015 epidemic in Sierra Leone, and the personal and ecological factors that shaped changes in stigma over time. Methods Using three waves of survey data from a representative sample in the Western Urban and Western Rural districts of Sierra Leone, this study examines factors associated with self-reported personal stigma toward Ebola survivors (11 items, α = 0.77) among 1008 adults (74.6% retention rate) from 63 census enumeration areas of the Western Rural and Western Urban districts of Sierra Leone. Participants were randomly sampled at the height of the EVD epidemic and followed up as the epidemic was waning and once the epidemic had been declared over by the WHO. Three-level mixed effects models were fit using Stata 16 SE to examine cross-sectional associations as well as predictors of longitudinal changes in stigma toward EVD survivors. Results At the height of the EVD epidemic, female sex, household wealth, post-traumatic stress, EVD-related fear and perceived infection risk are a few of the factors which predicted higher levels of stigma toward survivors. On average, stigma toward EVD survivors decreased significantly as the epidemic declined in Sierra Leone, but female sex, EVD fear, and risk perceptions predicted a slower rate of change. Conclusion This study identified key individual and psychosocial characteristics which may predict higher levels of stigma toward infectious disease survivors. Future studies should pursue a better understanding of how personal characteristics and perceptions, including psychosocial distress, fear, and perceived infection risk serve as pathways for stigma in communities affected by infectious disease. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12146-0.
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Affiliation(s)
- Cara M Antonaccio
- Research Program on Children and Adversity, Boston College School of Social Work, Boston, MA, USA
| | - Phuong Pham
- Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Patrick Vinck
- Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Robert T Brennan
- Research Program on Children and Adversity, Boston College School of Social Work, Boston, MA, USA.,Women's Studies Research Center, Brandeis University, Waltham, MA, USA
| | - Theresa S Betancourt
- Research Program on Children and Adversity, Boston College School of Social Work, Boston, MA, USA.
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Sensoy Bahar O, Cavazos-Rehg P, Ssewamala FM, Abente B, Peer L, Nabunya P, Soto de Laurido LE, Betancourt TS, Bhana A, Edmond T. Training LEADers to Accelerate Global Mental Health Disparities Research (LEAD) Program: A Research Training Program Protocol. Front Public Health 2021; 9:749627. [PMID: 34858929 PMCID: PMC8631301 DOI: 10.3389/fpubh.2021.749627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background: There is a critical need to address mental health needs across the globe, especially in low and middle-income countries where mental health disparities are pervasive, including among children. The global mental health disparities suggest an imperative for culturally and contextually-congruent mental health services models that expand upon the existing services and interventions for these groups. Rigorous research is a key tool in providing the scientific evidence to inform public policy and practice efforts to effectively address these needs. Yet, there is a limited number of researchers, especially those from diverse backgrounds, who study these issues. In this paper, we describe the "TrainingLEADers to Accelerate Global Mental Health Disparities Research" (LEAD) program, a research training program funded by the National Institute on Minority Health and Health Disparities and focused on global mental health disparities research for early career researchers from under-represented minority groups. Methods: The LEAD program is designed as a two-phase training program for advanced pre-doctoral students, postdoctoral fellows, and junior faculty from diverse backgrounds in the U.S., including groups underrepresented in biomedical, behavioral, clinical and social sciences research, interested in global mental health disparities research. Trainees are matched with mentors and participate in an intensive 12-week program. Discussion: The LEAD program seeks to provide a robust platform for the development, implementation and expansion of evidence-based culturally and contextually-congruent interventions and services models addressing global mental health disparities across the life cycle, especially in low-resource communities in the global context. By producing a sustainable network of well-trained investigators from underrepresented backgrounds, LEAD will potentially contribute to the shared lessons and efforts relevant to addressing global mental health disparities and improving care for vulnerable populations in low-resource settings.
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Affiliation(s)
- Ozge Sensoy Bahar
- Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Fred M. Ssewamala
- Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Betsy Abente
- Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Laura Peer
- Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Proscovia Nabunya
- Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | | | | | - Arvin Bhana
- South African Medical Research Council, Cape Town, South Africa
- Centre for Rural Health-School of Nursing & Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Tonya Edmond
- Brown School, Washington University in St. Louis, St. Louis, MO, United States
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Grieco-Page H, Black CJ, Berent JM, Gautam B, Betancourt TS. Beyond the Pandemic: Leveraging Rapid Expansions in U.S. Telemental Health and Digital Platforms to Address Disparities and Resolve the Digital Divide. Front Psychiatry 2021; 12:671502. [PMID: 34421669 PMCID: PMC8377496 DOI: 10.3389/fpsyt.2021.671502] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/14/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Haley Grieco-Page
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA, United States
| | - Candace J. Black
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA, United States
| | - Jenna M. Berent
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA, United States
| | - Bhuwan Gautam
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA, United States
- Bhutanese Society of Western Massachusetts, Springfield, MA, United States
| | - Theresa S. Betancourt
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA, United States
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Affiliation(s)
- Sarah K G Jensen
- Boston College School of Social Work, Chestnut Hill, Massachusetts
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30
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Jensen SKG, Sezibera V, Murray SM, Brennan RT, Betancourt TS. Intergenerational impacts of trauma and hardship through parenting. J Child Psychol Psychiatry 2021; 62:989-999. [PMID: 33284991 DOI: 10.1111/jcpp.13359] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Millions of people worldwide experience severe trauma in their lifetime. Trauma has immediate and long-term effects on emotional wellbeing. Moreover, the experiences of one generation may influence subsequent generations via social and biological pathways. Poor mental health and emotion dysregulation associated with trauma may affect parenting behaviours, which may have long-lasting effects on children's development. METHODS We use longitudinal data from a unique sample of 732 caregivers of children aged 6-36 months living in extremely poor rural households in Rwanda to examine associations of caregiver lifetime trauma, recent daily hardships, mental health, and emotion dysregulation with parenting behaviours reflecting parental acceptance and rejection of their offspring. RESULTS Cumulative trauma exposure (β = .234, p < .001) and recent daily hardships (β = .323, p < .001) are associated with higher levels of internalising symptoms. Trauma (β = .257, p < .001) and daily hardships (β = .323, p < 0.001) are also associated with post-traumatic stress disorder (PTSD) symptoms. Internalising symptoms predict more rejection (β = .177, p = .001), but show no association with acceptance. Caregiver PTSD symptoms predict more rejection (β = .277, p < .001) and less acceptance (β = -.190, p = .003). Both internalising symptoms (β = .557, p < .001) and PTSD symptoms (β = .606, p < .001) are strongly associated with poor emotion regulation. Indirect effects suggest that caregiver trauma and hardships affect parenting indirectly via elevated caregiver internalising symptoms and PTSD and that some of these effects are accounted for by emotion dysregulation. CONCLUSIONS Caregiver internalising and PTSD symptoms are important mechanisms through which caregiver trauma and hardship affect parenting behaviours. Emotion dysregulation is a shared mechanism linking caregivers' mental health problems with parenting behaviours that reflect acceptance and rejection of the child. Emotion regulation is indicated as a key target for prevention of adverse effects of caregiver trauma on mental health and child wellbeing.
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Affiliation(s)
- Sarah K G Jensen
- Boston College School of Social Work, Boston College, Chestnut Hill, MA, USA
| | | | - Shauna M Murray
- Boston College School of Social Work, Boston College, Chestnut Hill, MA, USA
| | - Robert T Brennan
- Boston College School of Social Work, Boston College, Chestnut Hill, MA, USA.,Women's Study Research Center, Brandeis University, Waltham, MA, USA
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Jensen SK, Placencio-Castro M, Murray SM, Brennan RT, Goshev S, Farrar J, Yousafzai A, Rawlings LB, Wilson B, Habyarimana E, Sezibera V, Betancourt TS. Effect of a home-visiting parenting program to promote early childhood development and prevent violence: a cluster-randomized trial in Rwanda. BMJ Glob Health 2021; 6:bmjgh-2020-003508. [PMID: 33514591 PMCID: PMC7849888 DOI: 10.1136/bmjgh-2020-003508] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/03/2020] [Accepted: 12/23/2020] [Indexed: 11/20/2022] Open
Abstract
Introduction Families living in extreme poverty require interventions to support early-childhood development (ECD) due to broad risks. This longitudinal cluster randomised trial examines the effectiveness of Sugira Muryango (SM), a home-visiting intervention linked to Rwanda’s social protection system to promote ECD and reduce violence compared with usual care (UC). Methods Families with children aged 6–36 months were recruited in 284 geographical clusters across three districts. Cluster-level randomisation (allocated 1:1 SM:UC) was used to prevent diffusion. SM was hypothesised to improve child development, reduce violence and increase father engagement. Developmental outcomes were assessed using the Ages and Stages Questionnaire (ASQ-3) and the Malawi Development Assessment Tool (MDAT) and anthropometric assessments of growth. Violence was assessed using questions from UNICEF Multiple Indicators Cluster Survey (MICS) and Rwanda Demographic and Health Surveys (DHS). Father engagement was assessed using the Home Observation for Measurement of the Environment. Blinded enumerators conducted interviews and developmental assessments. Results A total of 541 SM families and 508 UC families were enrolled and included in the analyses. Study attrition (2.0% children; 9.6% caregivers) was addressed by hot deck imputation. Children in SM families improved more on gross motor (d=0.162, 95% CI 0.065 to 0.260), communication (d=0.081, 95% CI 0.005 to 0.156), problem solving (d=0.101, 95% CI 0.002 to 0.179) and personal-social development (d=0.096, 95% CI −0.015 to 0.177) on the ASQ-3. SM families showed increased father engagement (OR=1.592, 95% CI 1.069 to 2.368), decreased harsh discipline (incidence rate ratio, IRR=0.741, 95% CI 0.657 to 0.835) and intimate partner violence (IRR=0.616, 95% CI:0.458 to 0.828). There were no intervention-related improvements on MDAT or child growth. Conclusion Social protection programmes provide a means to deliver ECD intervention. Trial registration number NCT02510313.
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Affiliation(s)
- Sarah Kg Jensen
- School of Social Work, Boston College, Chestnut Hill, Massachusetts, USA
| | - Matias Placencio-Castro
- Lynch School of Education and Human Development, Boston College, Chestnut Hill, Massachusetts, USA
| | - Shauna M Murray
- School of Social Work, Boston College, Chestnut Hill, Massachusetts, USA
| | - Robert T Brennan
- School of Social Work, Boston College, Chestnut Hill, Massachusetts, USA.,Women's Study Research Center, Brandeis University, Waltham, Massachusetts, USA
| | - Simo Goshev
- Academic Research Services, Boston College, Chestnut Hill, Massachusetts, USA
| | - Jordan Farrar
- School of Social Work, Boston College, Chestnut Hill, Massachusetts, USA
| | - Aisha Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Briana Wilson
- The World Bank, Washington, District of Columbia, USA
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O’Connor R, Betancourt TS, Enelamah NV. Safeguarding the Lives of Children Affected by Boko Haram: Application of the SAFE Model of Child Protection to a Rights-Based Situation Analysis. Health Hum Rights 2021; 23:27-41. [PMID: 34194199 PMCID: PMC8233023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The Boko Haram insurgency in northeast Nigeria is responsible for the highest number of lives lost in Africa in the past decade. The country has witnessed significant violations of the United Nations Convention on the Rights of the Child, which Nigeria has signed and ratified. For instance, Nigeria had the second-highest number of children recruited to armed groups and the third-highest number of abductions in 2018. Current humanitarian efforts primarily target camps for internally displaced persons, while state strategies focus mainly on addressing security through combatant-targeted interventions. However, there is a need for more rights-based, integrated, and multifaceted approaches to tackle the interrelated threats to the security of children and their families affected by the conflict. This paper uses the SAFE model of child protection-which examines the interrelatedness of safety, access, family, and education and economic security-to analyze the challenges of children and youth affected by the conflict. We highlight the need for a gendered approach; strategies that address poverty and cultural and governance barriers; and interdisciplinary, context-specific, and autonomous child protection systems. The paper calls for urgent and increased attention to the core rights and human security needs of these children to avoid a replay of negative outcomes of conflict, where the costs and consequences propagate a cycle of violence and disadvantage.
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Affiliation(s)
- Rosie O’Connor
- Social Worker at Refugees Northwest Foster Care, Seattle, USA
| | - Theresa S. Betancourt
- Salem Professor in Global Practice and Director of the Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, USA.,Please address correspondence to Theresa S. Betancourt.
| | - Ngozi V. Enelamah
- Assistant Professor at the University of New Hampshire Department of Social Work, Durham, USA
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Su S, Frounfelker RL, Desrosiers A, Brennan RT, Farrar J, Betancourt TS. Classifying childhood war trauma exposure: latent profile analyses of Sierra Leone's former child soldiers. J Child Psychol Psychiatry 2021; 62:751-761. [PMID: 32860231 DOI: 10.1111/jcpp.13312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/17/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Former child soldiers are at elevated risk for mental health problems (e.g., traumatic stress, emotion dysregulation, and internalizing and externalizing problems). To examine which groups of former child soldiers are more likely to have difficulties with emotion regulation, interpersonal relationships, and mental health postconflict, we explored patterns of war trauma exposure and their effects on subsequent mental health problems among former child soldiers in Sierra Leone. METHODS Participants were 415 (23.86% female) Sierra Leonean former child soldiers participating in a 15-year, four-wave longitudinal study. At T1 (2002), 282 former child soldiers (aged 10-17) were recruited. T2 (2004) included 186 participants from T1 and an additional cohort of self-reintegrated former child soldiers (NT2 = 132). T3 (2008) and T4 (2016/2017) participants were youth enrolled in previous waves (NT3 = 315; NT4 = 364). Latent profile analysis (LPA) was used to classify participants based on the first-time reports of eight forms of war exposure (separation and loss of assets, parental loss, loss of loved ones, witnessing violence, victimization, perpetrating violence, noncombat activities, and deprivation). ANOVA examined whether patterns of war exposure were associated with sociodemographic characteristics and mental health outcomes between T1 and T4. RESULTS LPA identified two profiles: higher exposure versus lower exposure, using cumulative scores of eight forms of war-related trauma exposure. The 'higher war exposure' group comprised 226 (54.5%) former child soldiers and the 'lower war exposure' group included 189 (45.5%). Significantly higher levels of violence-related and combat experiences characterized the group exposed to more traumatic events. The 'higher war exposure' group reported more PTSD symptoms at T2, more hyperarousal symptoms across all waves, and more difficulties in emotion regulation at T4. CONCLUSIONS Former child soldiers exposed to higher levels of war-related traumatic events and loss should be prioritized for mental health services immediately postconflict and as they transition into adulthood.
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Affiliation(s)
- Shaobing Su
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA, USA
| | - Rochelle L Frounfelker
- Division of Social and Transcultural Psychiatry, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Alethea Desrosiers
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA, USA
| | - Robert T Brennan
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA, USA
- Women's Study Research Center, Brandeis University, Waltham, MA, USA
| | - Jordan Farrar
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA, USA
| | - Theresa S Betancourt
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA, USA
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Perlo J, Colocci I, Rajagopal SS, Betancourt TS, Pradeep A, Mayer KH, Kumarasamy N, O'Cleirigh C, Chan BT. The Convergence of Disclosure Concerns and Poverty Contributes to Loss to HIV Care in India: A Qualitative Study. J Int Assoc Provid AIDS Care 2021; 19:2325958220934606. [PMID: 32573330 PMCID: PMC7313324 DOI: 10.1177/2325958220934606] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
In India, there is little evidence on reasons for high rates of loss to HIV care. We conducted a clinic-based qualitative study at the YR Gaitonde Centre for AIDS Research and Education to explore factors that influence loss to care. In all, 17 men and 14 women were interviewed; median age was 42 (interquartile range [IQR], 36-48) and median CD4 count was 448 (IQR, 163-609). A majority reported avoiding treatment freely available at nearby government facilities because of disclosure concerns and perceptions of poor quality. As a result, participants sought care in the private sector where they were subjected to medication and transport costs. Life circumstances causing lost wages or unexpected expenditures therefore prevented participants from attending clinic, resulting in loss to care. Improving perceptions of quality of care in the public sector, addressing disclosure concerns, and reducing economic hardships among people living with HIV may be important in reducing loss to HIV care in India.
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Affiliation(s)
| | | | | | - Theresa S Betancourt
- School of Social Work and Research Program on Children and Adversity, Boston College, Boston, MA, USA
| | - Amrose Pradeep
- YR Gaitonde Centre for AIDS Research and Education, Chennai, India
| | - Kenneth H Mayer
- Fenway Health, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | - Conall O'Cleirigh
- Fenway Health, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Behavioral Medicine and Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Brian T Chan
- Harvard Medical School, Boston, MA, USA.,Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA
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Alleyne-Green B, Kulick A, Grocher K, Betancourt TS. Physical and Sexual Violence Experienced by Male War-Affected Youth: Implications for Post-Conflict Functioning and Intimate Relationships. J Interpers Violence 2021; 36:NP4874-NP4890. [PMID: 30141718 DOI: 10.1177/0886260518792963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study explored the association between war violence exposure during armed conflict and intimate partner violence (IPV) victimization, and the impact of positive community and family reintegration on IPV among a sample (N = 92) of war-affected male youth, post-conflict Sierra Leone. Trained Sierra Leonean researchers conducted face-to-face interviews with youth and their caregivers. Results indicate that exposure to violence during armed conflict as well as community and family reintegration were negatively associated with psychological IPV perpetration. Community reintegration was negatively associated with physical IPV. Sexual victimization was negatively associated with sexual IPV perpetration, whereas physical victimization had positive association. More research needs to be done on male war-affected youth as victims of physical, psychological, and sexual violence during conflict and the impact this has on the quality of their intimate relationships, occurrence of IPV in those relationships (as victims in addition to being perpetrators), and their community reintegration.
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Affiliation(s)
| | - Alex Kulick
- University of California, Santa Barbara, USA
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Betancourt TS, Hansen N, Farrar J, Borg RC, Callands T, Desrosiers A, Antonaccio CM, Williams MJ, Bangura J, Brennan RT. Youth Functioning and Organizational Success for West African Regional Development (Youth FORWARD): Study Protocol. Psychiatr Serv 2021; 72:563-570. [PMID: 33291974 DOI: 10.1176/appi.ps.202000009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND This article describes the incorporation of an evidence-based mental health intervention, the Youth Readiness Intervention (YRI), into a youth entrepreneurship training program in Sierra Leone. A collaborative team approach (CTA) was used as the implementation strategy to address the human resource shortage and related challenges associated with capacity and access to care. METHODS A cluster randomized quasi-experimental pilot trial (N=175) was conducted in one rural district of Sierra Leone. Pilot data assessed implementation feasibility and clinical effectiveness when using a CTA. A larger hybrid type-2 effectiveness-implementation cluster randomized trial is underway (N=1,151) in three rural districts. Findings on feasibility and fidelity, barriers and facilitators influencing the integration of the YRI into the entrepreneurship program, and clinical effectiveness of the YRI are of interest. RESULTS Findings from the pilot study indicated that the YRI can be implemented within a youth entrepreneurship program and provide mental health benefits to youths at high risk of emotion dysregulation and interpersonal deficits. Pilot findings informed the ongoing, larger hybrid type-2 trial to understand barriers and facilitators of the CTA and clinical effectiveness of the YRI within youth employment programming. NEXT STEPS In fragile postconflict settings, innovative approaches are needed to address the mental health treatment gap. Findings from this study will support efforts by the government of Sierra Leone and its partners to address human resource challenges and increase access to evidence-based mental health services.
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Affiliation(s)
- Theresa S Betancourt
- School of Social Work, Boston College, Chestnut Hill, Massachusetts (Betancourt, Farrar, Borg, Desrosiers, Antonaccio, Brennan); College of Public Health, University of Georgia, Athens (Hansen, Callands); National Institute of Mental Health (NIMH) and National Heart, Lung, and Blood Institute (NHLBI), Bethesda, Maryland (Williams); Caritas Freetown, Freetown, Sierra Leone (Bangura); Women's Study Research Center, Brandeis University, Waltham, Massachusetts (Brennan)
| | - Nathan Hansen
- School of Social Work, Boston College, Chestnut Hill, Massachusetts (Betancourt, Farrar, Borg, Desrosiers, Antonaccio, Brennan); College of Public Health, University of Georgia, Athens (Hansen, Callands); National Institute of Mental Health (NIMH) and National Heart, Lung, and Blood Institute (NHLBI), Bethesda, Maryland (Williams); Caritas Freetown, Freetown, Sierra Leone (Bangura); Women's Study Research Center, Brandeis University, Waltham, Massachusetts (Brennan)
| | - Jordan Farrar
- School of Social Work, Boston College, Chestnut Hill, Massachusetts (Betancourt, Farrar, Borg, Desrosiers, Antonaccio, Brennan); College of Public Health, University of Georgia, Athens (Hansen, Callands); National Institute of Mental Health (NIMH) and National Heart, Lung, and Blood Institute (NHLBI), Bethesda, Maryland (Williams); Caritas Freetown, Freetown, Sierra Leone (Bangura); Women's Study Research Center, Brandeis University, Waltham, Massachusetts (Brennan)
| | - Ryan C Borg
- School of Social Work, Boston College, Chestnut Hill, Massachusetts (Betancourt, Farrar, Borg, Desrosiers, Antonaccio, Brennan); College of Public Health, University of Georgia, Athens (Hansen, Callands); National Institute of Mental Health (NIMH) and National Heart, Lung, and Blood Institute (NHLBI), Bethesda, Maryland (Williams); Caritas Freetown, Freetown, Sierra Leone (Bangura); Women's Study Research Center, Brandeis University, Waltham, Massachusetts (Brennan)
| | - Tamora Callands
- School of Social Work, Boston College, Chestnut Hill, Massachusetts (Betancourt, Farrar, Borg, Desrosiers, Antonaccio, Brennan); College of Public Health, University of Georgia, Athens (Hansen, Callands); National Institute of Mental Health (NIMH) and National Heart, Lung, and Blood Institute (NHLBI), Bethesda, Maryland (Williams); Caritas Freetown, Freetown, Sierra Leone (Bangura); Women's Study Research Center, Brandeis University, Waltham, Massachusetts (Brennan)
| | - Alethea Desrosiers
- School of Social Work, Boston College, Chestnut Hill, Massachusetts (Betancourt, Farrar, Borg, Desrosiers, Antonaccio, Brennan); College of Public Health, University of Georgia, Athens (Hansen, Callands); National Institute of Mental Health (NIMH) and National Heart, Lung, and Blood Institute (NHLBI), Bethesda, Maryland (Williams); Caritas Freetown, Freetown, Sierra Leone (Bangura); Women's Study Research Center, Brandeis University, Waltham, Massachusetts (Brennan)
| | - Cara M Antonaccio
- School of Social Work, Boston College, Chestnut Hill, Massachusetts (Betancourt, Farrar, Borg, Desrosiers, Antonaccio, Brennan); College of Public Health, University of Georgia, Athens (Hansen, Callands); National Institute of Mental Health (NIMH) and National Heart, Lung, and Blood Institute (NHLBI), Bethesda, Maryland (Williams); Caritas Freetown, Freetown, Sierra Leone (Bangura); Women's Study Research Center, Brandeis University, Waltham, Massachusetts (Brennan)
| | - Makeda J Williams
- School of Social Work, Boston College, Chestnut Hill, Massachusetts (Betancourt, Farrar, Borg, Desrosiers, Antonaccio, Brennan); College of Public Health, University of Georgia, Athens (Hansen, Callands); National Institute of Mental Health (NIMH) and National Heart, Lung, and Blood Institute (NHLBI), Bethesda, Maryland (Williams); Caritas Freetown, Freetown, Sierra Leone (Bangura); Women's Study Research Center, Brandeis University, Waltham, Massachusetts (Brennan)
| | - Joseph Bangura
- School of Social Work, Boston College, Chestnut Hill, Massachusetts (Betancourt, Farrar, Borg, Desrosiers, Antonaccio, Brennan); College of Public Health, University of Georgia, Athens (Hansen, Callands); National Institute of Mental Health (NIMH) and National Heart, Lung, and Blood Institute (NHLBI), Bethesda, Maryland (Williams); Caritas Freetown, Freetown, Sierra Leone (Bangura); Women's Study Research Center, Brandeis University, Waltham, Massachusetts (Brennan)
| | - Robert T Brennan
- School of Social Work, Boston College, Chestnut Hill, Massachusetts (Betancourt, Farrar, Borg, Desrosiers, Antonaccio, Brennan); College of Public Health, University of Georgia, Athens (Hansen, Callands); National Institute of Mental Health (NIMH) and National Heart, Lung, and Blood Institute (NHLBI), Bethesda, Maryland (Williams); Caritas Freetown, Freetown, Sierra Leone (Bangura); Women's Study Research Center, Brandeis University, Waltham, Massachusetts (Brennan)
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Desrosiers A, Schafer C, Esliker R, Jambai M, Betancourt TS. Correction: mHealth-Supported Delivery of an Evidence-Based Family Home-Visiting Intervention in Sierra Leone: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e28359. [PMID: 33690144 PMCID: PMC7991986 DOI: 10.2196/28359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Carolyn Schafer
- Boston College, School of Social Work, Chestnut Hill, MA, United States
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Desrosiers A, Schafer C, Esliker R, Jambai M, Betancourt TS. Correction: mHealth-Supported Delivery of an Evidence-Based Family Home-Visiting Intervention in Sierra Leone: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e27711. [PMID: 33539311 PMCID: PMC7892282 DOI: 10.2196/27711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/03/2021] [Indexed: 12/02/2022] Open
Affiliation(s)
| | - Carolyn Schafer
- Boston College, School of Social Work, Chestnut Hill, MA, United States
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Assefa MT, Frounfelker RL, Tahir SA, Berent JM, Abdi A, Betancourt TS. Traditional Medicine and Help-Seeking Behaviors for Health Problems Among Somali Bantu Refugees Resettled in the United States. Qual Health Res 2021; 31:484-497. [PMID: 33251964 DOI: 10.1177/1049732320970492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Somali refugees have resettled in the United States in large numbers. The focus of this study was specifically on the Somali Bantu refugees, an ethnic minority group from Somalia. The goal of this study was to understand the following: (a) jinn (invisible beings or forces in Islamic theology) and related health problems resulting from jinn possession affecting Somali Bantu refugees, (b) types of traditional healing practices integrated into help-seeking behavior, and (c) pathways of care utilized to address health problems. In total, 20 participant interviews were conducted with Somali Bantu refugees resettled in the United States. Overall, participants described types of jinn and associated health problems. In addition, participants identified different pathways of care, including formal and informal health care. Participants accessed these pathways both concurrently and sequentially. Somali Bantu utilize complex and varied health care services based on their understanding of the causes of health problems and experiences with care providers.
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Affiliation(s)
- Mehret T Assefa
- Stanford University School of Medicine, Stanford, California, USA
| | | | | | - Jenna M Berent
- Boston College School of Social Work, Chestnut Hill, Massachusetts, USA
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Mattingly TJ, Kiser L, Hill S, Briggs EC, Trunzo CP, Zafari Z, Betancourt TS. Unseen Costs: The Direct and Indirect Impact of U.S. Immigration Policies on Child and Adolescent Health and Well-Being. J Trauma Stress 2020; 33:873-881. [PMID: 32790957 PMCID: PMC7754407 DOI: 10.1002/jts.22576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 05/14/2020] [Accepted: 06/09/2020] [Indexed: 11/16/2022]
Abstract
Shifts in migration and border control policies may increase the likelihood of trauma exposure related to child-parent separation and result in costs to the health system and society. In the present study, we estimated direct and indirect costs per child as well as overall cohort costs of border control policies on migrant children and adolescents who were separated from their parents, detained, and placed in the custody of the United States following the implementation of the 2018 Zero Tolerance Policy. Economic modeling techniques, including a Markov process and Monte Carlo simulation, based on data from the National Child Traumatic Stress Network's Core Data Set (N = 458 migrant youth) and published studies were used to estimate economic costs associated with three immigration policies: No Detention, Family Detention, and Zero Tolerance. Clinical evaluation data on mental health symptoms and disorders were used to estimate the initial health state and risks associated with additional trauma exposure for each scenario. The total direct and indirect costs per child were conservatively estimated at $33,008, $33,790, and $34,544 after 5 years for No Detention, Family Detention, and Zero Tolerance, respectively. From a health system perspective, annual estimated spending increases ranged from $1.5 million to $14.9 million for Family Detention and $2.8 million to $29.3 million for Zero Tolerance compared to baseline spending under the No Detention scenario. Border control policies that increase the likelihood of child and adolescent trauma exposure are not only morally troubling but may also create additional economic concerns in the form of direct health care costs and indirect societal costs.
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Affiliation(s)
- T. Joseph Mattingly
- Department of Pharmaceutical Health Services ResearchUniversity of Maryland School of PharmacyBaltimoreMarylandUSA
| | - Laurel Kiser
- Department of PsychiatryUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Sherika Hill
- UCLA/Duke University National Center for Child Traumatic StressDepartment of Psychiatry and Behavioral SciencesDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Ernestine C. Briggs
- UCLA/Duke University National Center for Child Traumatic StressDepartment of Psychiatry and Behavioral SciencesDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Carrie Purbeck Trunzo
- UCLA/Duke University National Center for Child Traumatic StressDepartment of Psychiatry and Behavioral SciencesDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Zafar Zafari
- Department of Pharmaceutical Health Services ResearchUniversity of Maryland School of PharmacyBaltimoreMarylandUSA
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Affiliation(s)
- Anushka Ataullahjan
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Theresa S Betancourt
- Research Program on Children and Adversity, Boston College School of Social Work, Boston, USA
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
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Rahman A, Naslund JA, Betancourt TS, Black CJ, Bhan A, Byansi W, Chen H, Gaynes BN, Restrepo CG, Gouveia L, Hamdani SU, Marsch LA, Petersen I, Bahar OS, Shields-Zeeman L, Ssewamala F, Wainberg ML. The NIMH global mental health research community and COVID-19. Lancet Psychiatry 2020; 7:834-836. [PMID: 32846142 PMCID: PMC7443356 DOI: 10.1016/s2215-0366(20)30347-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/11/2020] [Accepted: 07/13/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Atif Rahman
- Institute of Population Health Sciences, University of Liverpool, Liverpool L69 3BX, UK.
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | | | | | | | - William Byansi
- Brown School, Washington University in St Louis, St Louis, MO, USA
| | - Hongtu Chen
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
| | - Bradley N Gaynes
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | | - Lídia Gouveia
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Syed Usman Hamdani
- Institute of Population Health Sciences, University of Liverpool, Liverpool L69 3BX, UK
| | - Lisa A Marsch
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Inge Petersen
- Centre for Rural Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | | | - Laura Shields-Zeeman
- Netherlands Institute for Mental Health and Addiction (Trimbos Institute), Utrecht, Netherlands
| | - Fred Ssewamala
- Brown School, Washington University in St Louis, St Louis, MO, USA
| | - Milton L Wainberg
- Department of Psychiatry, New York State, Columbia University, New York, NY, USA
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Betancourt TS, Keegan K, Farrar J, Brennan RT. The intergenerational impact of war on mental health and psychosocial wellbeing: lessons from the longitudinal study of war-affected youth in Sierra Leone. Confl Health 2020; 14:62. [PMID: 32884581 PMCID: PMC7461150 DOI: 10.1186/s13031-020-00308-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background Globally, one in four children lives in a country affected by armed conflict or disaster often accompanied by exposure to a range of adversities including violent trauma and loss. Children involved with armed groups (often referred to as "child soldiers") typically exhibit high levels of mental health needs linked to their experiences. The Longitudinal Study of War-Affected Youth (LSWAY) in Sierra Leone is a seventeen-year prospective longitudinal study of the long-term effects of children's experiences in the country's eleven-year (1991-2002) civil war on their adult mental health and functioning in addition to exploring the potential mechanisms by which intergenerational transmission of emotional and behavioral disruptions due to war trauma may operate. LSWAY illuminates how war-related and post-conflict experiences shape long-term adult functioning, family dynamics, and developmental outcomes in offspring. Discussion The LSWAY study utilizes mixed methodologies that incorporate qualitative and quantitative data to unpack risk and protective factors involved in social reintegration, psychosocial adjustment, parenting, and interpersonal relationships. To date, study findings demonstrate striking levels of persistent mental health problems among former child soldiers as adults with consequences for their families, but also risk and protective patterns that involve family- and community-level factors. This case study examines the course of LSWAY from inception through implementation and dissemination, including building on the study results to design and evaluate several intervention models. Conclusion The case study offers a unique perspective on challenges and field realities of health research in a fragile, post-conflict setting common in the context of humanitarian emergencies. LSWAY findings along with lessons learned from the field can inform future research as well as intervention research and implementation science to address the mental health and development of war-affected young people. With four waves of data collection and a planned fifth wave, LSWAY also provides rare insights into the intergenerational effects of humanitarian crises on children, youth, and families across generations.
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Affiliation(s)
- Theresa S Betancourt
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA USA
| | - Katrina Keegan
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA USA
| | - Jordan Farrar
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA USA
| | - Robert T Brennan
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA USA.,Women's Studies Research Center, Brandeis University, Waltham, MA USA
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Betancourt TS, Thomson DL, Brennan RT, Antonaccio CM, Gilman SE, VanderWeele TJ. Stigma and Acceptance of Sierra Leone's Child Soldiers: A Prospective Longitudinal Study of Adult Mental Health and Social Functioning. J Am Acad Child Adolesc Psychiatry 2020; 59:715-726. [PMID: 31176749 PMCID: PMC6908764 DOI: 10.1016/j.jaac.2019.05.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 04/26/2019] [Accepted: 05/30/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the associations of war and postconflict factors with mental health among Sierra Leone's former child soldiers as adults. METHOD In 2002, we recruited former child soldiers from lists of soldiers (aged 10-17 years) served by Disarmament, Demobilization, Reintegration centers and from a random door-to-door sample in 5 districts of Sierra Leone. In 2004, self-reintegrated child soldiers were recruited in an additional district. At 2016/2017, 323 of the sample of 491 former child soldiers were reassessed. Subjects reported on war exposures and postconflict stigma, family support, community support, anxiety/depression, and posttraumatic stress symptoms. RESULTS Of the subjects, 72% were male, with a mean age of 28 years. In all, 26% reported killing or injuring others; 67% reported being victims of life-threatening violence; 45% of female subjects and 5% of male subjects reported being raped; and 32% reported death of a parent. In 2016/2017 (wave 4), 47% exceeded the threshold for anxiety/depression, and 28% exceeded the likely posttraumatic stress disorder threshold. Latent class growth analysis yielded 3 trajectory groups based on changes in stigma and family/community acceptance; "Improving Social Integration" (n = 77) fared nearly as well as the "Socially Protected" (n = 213). The "Socially Vulnerable" group (n = 33) had increased risk of anxiety/depression above the clinical threshold and possible PTSD, and were around 3 times more likely to attempt suicide. CONCLUSION Former child soldiers had elevated rates of mental health problems. Postconflict risk and protective factors related to outcomes long after the end of conflict. Targeted social inclusion and family interventions could benefit the long-term mental health of former child soldiers.
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Affiliation(s)
- Theresa S Betancourt
- Research Program on Children and Adversity, Boston College School of Social Work, Newton, Massachusetts.
| | | | - Robert T Brennan
- Research Program on Children and Adversity, Boston College School of Social Work, Newton, Massachusetts
| | - Cara M Antonaccio
- Research Program on Children and Adversity, Boston College School of Social Work, Newton, Massachusetts
| | - Stephen E Gilman
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, and the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Betancourt TS, Jensen SKG, Barnhart DA, Brennan RT, Murray SM, Yousafzai AK, Farrar J, Godfroid K, Bazubagira SM, Rawlings LB, Wilson B, Sezibera V, Kamurase A. Promoting parent-child relationships and preventing violence via home-visiting: a pre-post cluster randomised trial among Rwandan families linked to social protection programmes. BMC Public Health 2020; 20:621. [PMID: 32375840 PMCID: PMC7201751 DOI: 10.1186/s12889-020-08693-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 04/13/2020] [Indexed: 11/10/2022] Open
Abstract
Background Sugira Muryango is a father-engaged early child development and violence-prevention home-visiting programme delivered by trained lay workers. This cluster-randomised trial evaluates whether families living in extreme poverty (Ubudehe 1, the poorest category in the Government of Rwanda’s wealth ranking) who receive Sugira Muryango in combination with a government-provided social protection programme demonstrate greater responsive, positive caregiving, nutrition, care seeking, hygiene, and father involvement compared with control families receiving usual care (UC). Methods Using detailed maps, we grouped closely spaced villages into 284 geographic clusters stratified by the type of social protection programmes operating in the village clusters; 198 clusters met all enrolment criteria. Sugira Muryango was delivered to n = 541 families in 100 treatment clusters with children aged 6–36 months living in extreme poverty. We assessed changes in outcomes in intervention and n = 508 UC control families using structured surveys and observation. Analyses were intent to treat using mixed models to accommodate clustering. Results Families receiving Sugira Muryango improved on core outcomes of parent-child relationships assessed using the Home Observation for Measurement of the Environment (Cohen’s d = 0.87, 95% CI: 0.74, 0.99) and the Observation of Mother-Child Interaction (Cohen’s d = 0.29, 95% CI: 0.17, 0.41). We also saw reductions in harsh discipline on items from the UNICEF MICS (OR = 0.30: 95% CI: 0.19, 0.47) and in violent victimisation of female caregivers by their partners (OR = 0.49, 95% CI: 0.24, 1.00) compared with UC. Moreover, children in families receiving SM had a 0.45 higher increase in food groups consumed in the past 24 h (Cohen’s d = 0.35, 95% CI: 0.22, 0.47), increased care seeking for diarrhoea (OR = 4.43, 95% CI: 1.95, 10.10) and fever (OR = 3.28, 95% CI: 1.82, 5.89), and improved hygiene behaviours such as proper treatment of water (OR = 3.39, 95% CI: 2.16, 5.30) compared with UC. Finally, Sugira Muryango was associated with decreased caregiver depression and anxiety (OR = 0.58, 95% CI: 0.38, 0.88). Conclusions Sugira Muryango led to improvements in caregiver behaviours linked to child development and health as well as reductions in violence. Trial registration ClinicalTrials.gov number NCT02510313.
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Affiliation(s)
- Theresa S Betancourt
- Boston College School of Social Work, McGuinn Hall 106M, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA.
| | - Sarah K G Jensen
- Boston College School of Social Work, McGuinn Hall 106M, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA
| | - Dale A Barnhart
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Robert T Brennan
- Boston College School of Social Work, McGuinn Hall 106M, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA.,Women's Study Research Center, Brandeis University, Waltham, MA, USA
| | - Shauna M Murray
- Boston College School of Social Work, McGuinn Hall 106M, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA
| | - Aisha K Yousafzai
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA
| | - Jordan Farrar
- Boston College School of Social Work, McGuinn Hall 106M, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA
| | | | | | | | | | - Vincent Sezibera
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
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Purgato M, Tedeschi F, Betancourt TS, Bolton P, Bonetto C, Gastaldon C, Gordon J, O'Callaghan P, Papola D, Peltonen K, Punamaki RL, Richards J, Staples JK, Unterhitzenberger J, de Jong J, Jordans MJD, Gross AL, Tol WA, Barbui C. Mediators of focused psychosocial support interventions for children in low-resource humanitarian settings: analysis from an Individual Participant Dataset with 3,143 participants. J Child Psychol Psychiatry 2020; 61:584-593. [PMID: 31701533 DOI: 10.1111/jcpp.13151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Research on psychosocial interventions has been focused on the effectiveness of psychosocial interventions on mental health outcomes, without exploring how interventions achieve beneficial effects. Identifying the potential pathways through which interventions work would potentially allow further strengthening of interventions by emphasizing specific components connected with such pathways. METHODS We conducted a preplanned mediation analysis using individual participant data from a dataset of 11 randomized controlled trials (RCTs) which compared focused psychosocial support interventions versus control conditions for children living in low- and middle-income countries (LMICs) affected by humanitarian crises. Based on an ecological resilience framework, we hypothesized that (a) coping, (b) hope, (c) social support, and (d) functional impairment mediate the relationship between intervention and outcome PTSD symptoms. A systematic search on the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PubMed, PyscARTICLES, Web of Science, and the main local LMICs databases was conducted up to August 2018. The hypotheses were tested by using individual participant data obtained from study authors of all the studies included in the systematic review. RESULTS We included 3,143 children from 11 studies (100% of data from included studies), of which 1,877 from six studies contributed to the mediation analysis. Functional impairment was the strongest mediator for focused psychosocial interventions on PTSD (mediation coefficient -0.087, standard error 0.040). The estimated proportion of effect mediated by functional impairment, and adjusted for confounders, was 31%. CONCLUSIONS Findings did not support the proposed mediation hypotheses for coping, hope, and social support. The mediation through functional impairment may represent unmeasured proxy measures or point to a broader mechanism that impacts self-efficacy and agency.
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Affiliation(s)
- Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, University of Verona, Verona, Italy.,Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Federico Tedeschi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, University of Verona, Verona, Italy
| | - Theresa S Betancourt
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA, USA
| | - Paul Bolton
- Center for Humanitarian Health, Department of International Health and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Chiara Bonetto
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, University of Verona, Verona, Italy
| | - Chiara Gastaldon
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, University of Verona, Verona, Italy.,Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - James Gordon
- The Center for Mind-Body Medicine, Washington, D.C, USA
| | | | - Davide Papola
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, University of Verona, Verona, Italy
| | - Kirsi Peltonen
- Department of Psychology, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Raija-Leena Punamaki
- Department of Psychology, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Justin Richards
- School of Public Health & Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia.,Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | | | | | - Joop de Jong
- Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Mark J D Jordans
- Center for Global Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Wietse A Tol
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,HealthRight International, New York, NY, USA
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, University of Verona, Verona, Italy.,Cochrane Global Mental Health, University of Verona, Verona, Italy
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Shah SM, Al Dhaheri F, Albanna A, Al Jaberi N, Al Eissaee S, Alshehhi NA, Al Shamisi SA, Al Hamez MM, Abdelrazeq SY, Grivna M, Betancourt TS. Self-esteem and other risk factors for depressive symptoms among adolescents in United Arab Emirates. PLoS One 2020; 15:e0227483. [PMID: 31935233 PMCID: PMC6959560 DOI: 10.1371/journal.pone.0227483] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 12/20/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Little is known about depressive symptoms among adolescents in the United Arab Emirates (UAE). This study aimed to identify the prevalence of depression and its association with self-esteem, individual, parental and family factors among adolescents aged 12 to 18 in UAE. METHODS Six hundred adolescents, aged 12 to 18 years were recruited from 4 of 111 schools in a cross-sectional study. We administered Beck Depression Inventory Scale and Rosenberg Self-esteem Scale to measure self-report symptoms of depression and self-esteem. We used multiple linear regression to identify significant predictors of depression. RESULTS Over 86% of the identified sample participated to the survey. The mean age of the sample was 14.3 (±1.3) with an excess of girls (61%). Depressive symptoms were detected in 17.2% (95% CI 14.2-20.7). There was an inverse relationship between self-esteem scores and depressive symptoms. Positive predictors of depressive symptoms, having controlled for age, gender, and ethnicity included experiencing neglect, being verbally abused in school, having no monthly allowance to spend in school, a history of physical morbidities requiring treatment, being a current or past smoker and a low family income. CONCLUSION The high prevalence of depressive symptoms measured in this survey suggests a significant public health problem among adolescents in the UAE. Public health interventions aimed at facilitating education and early detection and potential treatment of depressive symptoms are a priority in the region.
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Affiliation(s)
- Syed M. Shah
- Institute of Public Health, College of Medicine & Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - Fatima Al Dhaheri
- Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ammar Albanna
- Child and Adolescent Mental Health Centre, Al Jalila Children’s Specialty Hospital, Dubai, UAE
| | - Najla Al Jaberi
- Division of Pediatric Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
| | | | | | - Shamma A. Al Shamisi
- Institute of Public Health, College of Medicine & Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - Maryam M. Al Hamez
- Institute of Public Health, College of Medicine & Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - Said Y. Abdelrazeq
- Department of Epidemiology and Public Health, University, Ottawa, Ottawa, Canada
| | - Michal Grivna
- Institute of Public Health, College of Medicine & Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - Theresa S. Betancourt
- Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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48
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Colocci I, Perlo J, Rajagopal SS, Betancourt TS, Pradeep A, Mayer KH, Kumarasamy N, O'Cleirigh C, Katz IT, Chan BT. Economic vulnerability and non-initiation of antiretroviral therapy in India: a qualitative study. AIDS Care 2020; 33:423-427. [PMID: 31928214 DOI: 10.1080/09540121.2020.1713973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In India, many people living with HIV (PLHIV) do not successfully initiate antiretroviral therapy (ART) after diagnosis. We conducted a clinic-based qualitative study at the Y.R. Gaitonde Centre for AIDS Research in Chennai, Tamil Nadu to explore factors that influence ART non-initiation. We interviewed 22 men and 15 women; median age was 42 (IQR, 36-48) and median CD4+ was 395 (IQR, 227-601). Participants were distrustful of HIV care freely available at nearby government facilities. Faced with the perceived need to access the private sector and therefore pay for medications and transportation costs, non-initiators with high CD4+ counts often decided to postpone ART until they experienced symptoms whereas non-initiators with low CD4+ counts often started ART but defaulted quickly after experiencing financial stressors or side effects. Improving perceptions of quality of care in the public sector, encouraging safe serostatus disclosure to facilitate stronger social support, and alleviating economic hardship may be important in encouraging ART initiation in India.
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Affiliation(s)
| | | | | | - Theresa S Betancourt
- School of Social Work and Research Program on Children and Adversity, Boston College, Boston, USA
| | - Amrose Pradeep
- Y.R. Gaitonde Centre for AIDS Research and Education, Chennai, India
| | - Kenneth H Mayer
- Fenway Health, Boston, USA.,Harvard Medical School, Boston, USA
| | | | - Conall O'Cleirigh
- Behavioral Medicine and Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, USA
| | - Ingrid T Katz
- Harvard Medical School, Boston, USA.,Department of Medicine, Brigham and Women's Hospital, Boston, USA.,MGH Global Health, Massachusetts General Hospital, Boston, USA.,Harvard Global Health Institute, Cambridge, USA
| | - Brian T Chan
- Harvard Medical School, Boston, USA.,Department of Medicine, Brigham and Women's Hospital, Boston, USA
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Frounfelker RL, Miconi D, Farrar J, Brooks MA, Rousseau C, Betancourt TS. Mental Health of Refugee Children and Youth: Epidemiology, Interventions, and Future Directions. Annu Rev Public Health 2020; 41:159-176. [PMID: 31910713 DOI: 10.1146/annurev-publhealth-040119-094230] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The number of refugee youth worldwide receives international attention and is a top priority in both academic and political agendas. This article adopts a critical eye in summarizing current epidemiological knowledge of refugee youth mental health as well as interventions aimed to prevent or reduce mental health problems among children and adolescents in both high- and low-to-middle-income countries. We highlight current challenges and limitations of extant literature and present potential opportunities and recommendations in refugee child psychiatric epidemiology and mental health services research for moving forward. In light of the mounting xenophobic sentiments we are presently witnessing across societies, we argue that, as a first step, all epidemiological and intervention research should advocate for social justice to guarantee the safety of and respect for the basic human rights of all refugee populations during their journey and resettlement. A constructive dialogue between scholars and policy makers is warranted.
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Affiliation(s)
| | - Diana Miconi
- Department of Psychiatry, McGill University, Montreal, QC H3A 1A1, Canada; , ,
| | - Jordan Farrar
- Research Program on Children and Adversity, School of Social Work, Boston College, Chestnut Hill, Massachusetts 02467, USA; ,
| | | | - Cécile Rousseau
- Department of Psychiatry, McGill University, Montreal, QC H3A 1A1, Canada; , ,
| | - Theresa S Betancourt
- Research Program on Children and Adversity, School of Social Work, Boston College, Chestnut Hill, Massachusetts 02467, USA; ,
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50
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Frounfelker RL, Tahir S, Abdirahman A, Betancourt TS. Stronger together: Community resilience and Somali Bantu refugees. Cultur Divers Ethnic Minor Psychol 2020; 26:22-31. [PMID: 30920250 PMCID: PMC6765444 DOI: 10.1037/cdp0000286] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Refugee populations are at risk of adverse mental health outcomes. It is important to identify refugee strengths at the community level that can be leveraged to overcome barriers to well-being. In pursuit of this goal, this study focuses on identifying what promotes community resilience among Somali Bantu refugees in the United States. METHOD Researchers used snowball-sampling strategies in a large New England city to recruit 81 Somali Bantu youth and adults to participate in 14 focus groups conducted between 2011 and 2013. Researchers used principles of thematic content analysis to analyze data specific to the construct of community resilience. RESULTS Authors identified 2 main components of Somali Bantu community resilience: independence and cultural preservation. There were 2 themes related to promoting community resilience among Somali Bantu: commitment to community, and religion and spirituality. CONCLUSIONS We discuss the importance of identifying culturally informed components of community resilience that can be used to develop services for refugee populations. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Rochelle L. Frounfelker
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Division of Social and Transcultural Psychiatry. McGill University
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